Author(s): Laishram Deepak Kumar1, Gurumayum Laxmikanta Sharma2, Bijoya Debnath3, Laishram Rajesh Singh4, Kaushik Debnath5
In our study, 50 cases of transurethral prostate biopsies were evaluated histopathologically in the Department of Pathology in collaboration with Department of Urology, Regional Institute of Medical Sciences, Imphal, from October 2013 to September 2015. Total PSA (tPSA) was estimated from serum samples in all cases.
MATERIALS AND METHODS
A total of 50 patients with elevated serum tPSA levels were inducted in this study and prostate needle biopsies taken. Matched prostatectomy specimens were also obtained for 7 cases. Specimens were kept in 10% formalin saline, grossing done and tissues processed. H and E stained sections were examined and the different histomorphological features noted. Gleason scoring system was used in cancers to stratify it.
Out of the 50 cases, 30 malignant (all adenocarcinomas), 4 premalignant and 16 benign cases were found. Gleason scoring on needle biopsies were compared against the prostatectomy specimens. In 5 carcinoma cases with Gleason score 3+3=6 on needle biopsy, 4 cases had similar findings in the corresponding prostatectomy specimens, however, it was upgraded in 1 case. Intermediate differentiation prostatic carcinomas with Gleason score 3+4=7 in needle biopsies were comparable with prostatectomy specimens in 2 cases. The differentiation of prostatic carcinoma vis-a-vis Gleason scoring correlated well with the PSA values. In carcinomas, tPSA value and the Gleason score had a very good correlation (rs = 0.908). Mean PSA value was found to increase from benign to premalignant and malignant cases, this was found to be statistically significant (p<0.05).
Use of newer technologies like MRI and serum PSA as a screening tool for prostate pathology have made it possible to identify prostate cancer at an earlier stage in younger age group and has an increased case detection rate. However, there is no marker to predict disease course and at times lead to overtreatment. Image-guided prostate biopsy has a good patient compliance and is advantageous for procurement of representative material. While literatures have claimed that MRI can distinguish benign from malignant lesions accurately, the age old ‘histopathology’ still remains the gold standard.