Evaluation of TURP specimen with special reference to prostatic intraepithelial neoplasia and prostatic cancer using light microscopy and immunohistochemical markers of P63, CK5/6, AMACR (p504s), and PSA

Abstract

Background: Prostate cancer is the world’s leading cause of cancer and the second cause of cancer-related death in men after lung cancer. The incidence of prostatic carcinoma is increasing with age. Prostate intraepithelial neoplasia can only be diagnosed by histopathological examination of prostate tissue. In practice, small foci of cancer and several morphological mimickers of different Gleason Grades were encountered leading to diagnosing difficulty. To overcome this pitfall, the use of HMW Cytokeratin’s 5 and 6 (CK5/6) or p63 or combination of these two with alpha-methyl acyl- COA-racemase (AMACR) is triple cocktail which is recommended. Aims and Objectives: The objectives of this study were to analyze the histomorphology of various non-neoplastic and neoplastic lesions of the prostate and to know the incidence of prostatic intraepithelial neoplasia in transurethral resection of prostate (TURP) specimen, to assess the usefulness of immunohistochemical analysis with a panel of markers (p63, CK5/6, AMACR [p504s], and prostate-specific antigen [PSA]) to confirm the diagnosis of prostatic intraepithelial neoplasia and prostate cancer, and to differentiate several benign mimickers of prostatic adenocarcinoma. Materials and Methods: It is a prospective study performed for 18 month from January 2020 to June 2021. Thirty TURP specimens were collected in 10% formalin and processed in the department of pathology, MCH, Kolkata. Results: In the present study, benign prostatic hyperplasia formed majority of cases (80%). The presence of AMACR and absence of basal cell specific marker p63 and CK5/6 confirm the presence of prostate cancer. Conclusion: High degree of association of HGPIN with prostatic Carcinoma, it is suggested that these HGPIN patients need close follow-up, observation, and investigation to rule out existence of carcinoma, especially in the peripheral zone.