Prostatic Intraepithelial Neoplasm Research Articles

Incidental Prostatic Adenocarcinoma in Open Prostatectomy Specimens: An Institutional Experience.

Prostatic diseases cause significant morbidity and mortality in African men. Most Nigerian patients presenting with huge prostate enlargement are availed open prostatectomy to relieve symptoms of prostatism. Some prostates removed for benign enlargement have indolent cancers that are only discovered after histopathological examination. The incidence of these incidental adenocarcinomas of the prostate varies widely. We carried out a 10-year retrospective review of open prostatectomy specimens received in the Department of Pathology, from January 2009 to December 2018. At grossing, a minimum of 6 cassettes were used depending on size, and tissue was taken from representative areas for microscopic examination. The data was analysed for the presence of, and the relationship between, incidental adenocarcinoma of the prostate and clinicopathological parameters in each case using relevant statistical tools in the SPSS version 23. Incidental adenocarcinoma of the prostate was found in 5.7% of 158 open prostatectomy specimens seen during the study period. High-grade prostatic intraepithelial neoplasm (HGPIN) was present in 1.9% of cases. Patients in the 7th and 8th decade accounted for 88.8% of all incidental adenocarcinomas. The mean weight of the excised glands was 89.8g (range10-500g). The weight of the prostate did not predict diagnosis of incidental adenocarcinoma. In-hospital consultation accounted for 66.9% of open prostatectomy samples received in the department but the majority (72.7%) of incidental adenocarcinomas were seen in specimens form external consultations. The tumours were mostly ISUP grade group one tumours. The rate of diagnosis of occult prostate cancer is low with majority of the tumours being well differentiated. Organ weight had no relationship with histological diagnosis. Cases managed outside the teaching hospital were more likely to have incidental prostate cancer.

Correlation of serum PSA level with histomorphologic study in prostatic diseases

Correlation of serum PSA level with histomorphologic study in prostatic diseases - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2018.0117, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Synoptic Versus Narrative Reporting of Prostate Biopsies at a Tertiary Healthcare Institution: Challenges, Successes, and Expectations

Abstract Objectives Cancer pathology reports are expected to contain all information required for patient management and disease surveillance. Moreover, reports for patients with prostate cancer have become increasingly complex with the addition of more pathological details. This study aimed to compare narrative and synoptic prostate cancer reports for core needle biopsies received at a tertiary hospital in Nigeria in order to determine which form was most complete according to international standards. Methods This study was conducted from January 2010 to December 2015 at the Lagos University Teaching Hospital, Lagos, Nigeria. All malignant prostate cancer histopathology reports received during this period were analyzed for the presence of important clinicopathological parameters, including the numbers of cores taken and those involved by the tumor, percentage of tumor involvement, Gleason score, and the presence of high-grade prostatic intraepithelial neoplasms (HGPINs) and perineural and lymphovascular invasion. Results A total of 83 reports were reviewed, of which 27 were in narrative and 56 in synoptic format. The documentation of clinicopathological characteristics in narrative reports was significantly incomplete compared to synoptic reports in recording the number of cores (33.3% versus 96.4%), number of cores involved by the tumor (11.1% versus 94.6%), percentage of cores involved by the tumor (3.7% versus 100.0%), and the presence of HGPINs (7.4% versus 100.0%) and perineural (59.3% versus 98.2%) and lymphovascular (48.1% versus 100.0%) invasion (P < .001 each). Conclusion Synoptic reports of malignant prostate cancer biopsies received at the Lagos University Teaching Hospital were found to contain more complete information than narrative reports.

Outcomes of Prostate Atypical Small Acinar Proliferation and High-Grade Prostate Intraepithelial Neoplasm Patients

Objective: Atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two pathological findings occasionally noted in prostate biopsies. Previous Western studies reported that they were associated with prostate cancer. However, none Taiwanese series report the subsequent cancer detection in ASAP and HGPIN patients. This study aimed to examine the results of repeated biopsies in the patients with ASAP and HGPIN. Materials and Methods: A total of 220 consecutive patients with ASAP and/or HGPIN at our institute between January 1990 and December 2010 were enrolled. Patient demographics and clinical information were extracted from the electronic database of our institute. Prostate biopsies were performed through transrectal ultrasound guidance. The patients who had concurrent prostate cancer (n = 51) and no repeated prostate biopsies (n = 103) were excluded from the study. Patients with biopsy pathologies reporting low-grade prostatic intraepithelial neoplasia (n = 2) were also excluded. The remaining 64 patients were available for the final analysis. Results: Nearly, 38, 24, and 2 patients were initially diagnosed as ASAP, HGPIN, and ASAP along with HGPIN, respectively. After 10 years of follow-up, 36.8% patients in ASAP group developed prostate cancer, while 16.7% in HGPIN group and 100% in ASAP + HGPIN group. Median time to developing prostate cancer were 20 months in ASAP group, 31 months in HGPIN group, and 48 months in ASAP + HGPIN group. There was no significant difference of prostate cancer development between ASAP and HGPIN group (P = 0.291). Only older age, classified by 65 years, was significantly associated with a higher detection rate of prostate cancer. Conclusion: Patients with the initial diagnosis of ASAP or PIN has a high risk of developing prostate cancer. Therefore, those patients should be well announced and followed regularly.

Synoptic Versus Narrative Reporting of Prostate Biopsies at a Tertiary Healthcare Institution: Challenges, successes and expectations

Cancer pathology reports are expected to contain all information required for patient management and disease surveillance. Moreover, reports for patients with prostate cancer have become increasingly complex with the addition of more pathological details. This study aimed to compare narrative and synoptic prostate cancer reports for core needle biopsies received at a tertiary hospital in Nigeria in order to determine which form was most complete according to international standards. This study was conducted from January 2010 to December 2015 at the Lagos University Teaching Hospital, Lagos, Nigeria. All malignant prostate cancer histopathology reports received during this period were analysed for the presence of important clinicopathological parameters, including the numbers of cores taken and those involved by the tumour, percentage of tumour involvement, Gleason score and the presence of high-grade prostatic intraepithelial neoplasms (HGPINs) and perineural and lymphovascular invasion. A total of 83 reports were reviewed, of which 27 were in narrative and 56 in synoptic format. The documentation of clinicopathological characteristics in narrative reports was significantly incomplete compared to synoptic reports in recording the number of cores (33.3% versus 96.4%), number of cores involved by the tumour (11.1% versus 94.6%), percentage of cores involved by the tumour (3.7% versus 100.0%) and the presence of HGPINs (7.4% versus 100.0%) and perineural (59.3% versus 98.2%) and lymphovascular (48.1% versus 100.0%) invasion (P <0.001 each). Synoptic reports of malignant prostate cancer biopsies received at the Lagos University Teaching Hospital were found to contain more complete information than narrative reports.

Minimal (Limited) Pseudohyperplastic Prostatic Adenocarcinoma in Needle Prostatic Biopsy.

Study of minimum adenocarcinoma has been done almost exclusively on conventional acinar adenocarcinoma. Pseudohyperplastic adenocarcinoma can be confused with benign lesions because of its well-differentiated appearance and has not been studied when the biopsy shows few malignant glands (limited carcinoma). We reviewed 94 pseudohyperplastic adenocarcinomas diagnosed in prostatic biopsies for a period of 12 years and selected those measuring less than 1 mm or involving less than 5% of the biopsied tissue. We also reviewed 200 consecutive consultations. Four (4.2%) of the 94 cases were limited pseudohyperplastic adenocarcinomas, and 3 were from consultations. Three of them were mistaken for hyperplastic nodules, prostatic adenosis, or prostatic intraepithelial neoplasm. The number of glands varied between 6 and 50 (average 23). Three nodular histological patterns were identified-nodular, adenosis-like, and pseudohyperplastic carcinoma resembling prostatic intraepithelial neoplasia. The diagnosis of adenocarcinoma was not related to the number of neoplastic glands. Histological criteria that were useful included: crowded medium to large glands, papillary infoldings, branching glands, straight luminal borders, hyperchromatic nuclei, nucleomegaly, and apparent nucleoli. Areas of transition to conventional acinar adenocarcinoma were useful in recognizing four of these neoplasms, but were barely apparent in 2 of them. Hyperchromatic nuclei were found in all cases, whereas apparent nucleoli and nucleomegaly were only present in 4. The architectural and cytological criteria for limited acinar adenocarcinoma are only partially useful in interpreting minimum pseudohyperplastic adenocarcinomas. Knowledge of the criteria for malignancy in both neoplasms is important in order to avoid underdiagnosis of malignancy.

Screening for prostate cancer in renal transplant candidates: Single-centre experience over 10 years

Objectives: The purpose of this article is to report 10 years of single-centre experience with prostate cancer screening in renal transplant candidates. Patients and methods: This is a single-centre retrospective analysis of results of prostate cancer screening as a part of renal pre-transplant workup. We included all male patients suitable for transplant workup over 10 years. Patients with persistently elevated prostate specific antigen were considered for prostate biopsy. Biopsy results, treatment data and short-term outcomes for patients diagnosed with prostate cancer were collected. Results: We identified 542 patients with a mean age of 52 years. Thirty-one (5.7%) patients were referred to a urologist. Twenty-three (74%) of those referred were biopsied. Histological findings for 10 biopsies (44%) were normal, three (13%) had prostatic intraepithelial neoplasm and nine patients (39%) had invasive adenocarcinoma. One case (4%) was inconclusive. All patients with a normal biopsy proceeded with pre-transplant workup. Out of nine patients diagnosed with prostate cancer, five were transplant listed, two were receiving treatment and two were subsequently deceased. Conclusion: Prostate specific antigen screening with repeat testing and the use of age-adjusted normal values led to the diagnosis of prostate cancer that had major implications for transplant listing. For the majority of cancers the diagnosis did not deny transplant surgery to patients but only delayed listing for transplant.

Correlation of prostate specific antigen level with histopathological findings in patients with prostatic disease

Background: Carcinoma of prostate is one of the common tumors of old age in men. Although there is great apprehension in these patients when they are associated with even mild increase in the prostate specific antigen level (PSA) which can be seen in various benign lesions of prostate. With digital rectal examination (DRE), prostate specific antigen (PSA) remains a major screening tool for early detection of prostate cancer. Materials and method: The study includes 150 cases who presented clinically as prostatic lesions and in whom the PSA levels and tissue biopsy was available and was further correlated among spectrum of prostatic disease. Results: All cases with abnormal DRE were turn out to be malignant lesion on biopsy and was found that the cut off of PSA level for malignancy was 19.5ng/ml. The median PSA levels for benign prostatic hyperplasia (BPH), prostatitis, prostate intraepithelial neoplasia (PIN) and adenocarcinoma is 5ng/ml, 10 ng/ml, 14 ng/ml and 81ng/ml respectively. Statistically there was no significant difference of the PSA levels between low grade prostate intraepithelial neoplasm and high grade. Conclusion: In Benign prostatic lesion, PSA level ranges between 0 to 4.0ng/ml. The cut off value of 19.5ng/ml of PSA is most sensitive and specific for the detection of malignant lesion in the prostate. In addition to elevated level of more than 4.0ng/ml and abnormal DRE with TURP biopsy is most useful and accurate diagnostic method for prostatic lesions. All raised PSA levels cases were not malignant thus it is required to use this biochemical marker judiciously to minimize the apprehension among these patients.

DO COLOR DUPLEX AND POWER DOPPLER SONOGRAPHY INCREASE THE DETECTION RATE OF PROSTATE CANCER?

Background: Although gray-scale Trans Rectal Ultrasonography (TRUS) was a major achievement in diagnosis of prostate cancer, it has several limitations. Expert users are not able to discriminate among images with more than 32 gray levels out of 256 displayed on a gray-scale image. Objective: The aim of the study was using color and power doppler in targeting prostatic biopsy and detecting prostate cancer. Patients and methods: This prospective study included 100 consecutive patients attended Al-Azhar University Hospitals and National Institute of Urologyand Nephrology with lower urinary tract symptoms (LUTS), and have either Prostatic Specific Antigen (PSA)> 4 ng/ml or abnormal prostate on digital rectal examination (DRE). Patients with coagulopathy, history of prostate cancer diagnosis or evidence of a prostatic intraepithelial neoplasm of any grade were excluded. All patients were subjected to (DRE), International Prostatic Symptoms Score (IPSS), complete laboratory investigation including PSA, pelvi-abdominal ultrasound, gray-scale, color and power doppler TRUS, and TRUS-guided systematic biopsies with other focal lesion-targeted biopsies. Results: Histopathological examination of cores taken from hypo-echoic lesions revealed adenocarcinoma in 24 cases: 6 out of them were of group (A), and 18 were of group (B). So, cancer was detected in 50 % (6/12) of hypo-echoic lesions in group (A), and in 64.3% (18/28) of group (B) which was statistically significant. Correlation between the cores taken from hyper-vascular areas and the results of histopathology revealed that cancer was detected in 38 (74.5%) out of 51 hyper-vascular areas (8 out of them were of group A, and 30 were of group B). So, the incidence of cancer detection in hyper-vascular areas in group B (83.3%) was higher than group A (53.3%) which was statistically significant. Conclusion: The combination of color and power doppler ultrasound and gray-scale TRUS increased the sensitivity of detecting prostate cancer while not decreasing the specificity.

Biopsy follow-up in patients with atypical small acinar proliferation and prostate intraepithelial neoplasm in prostate biopsy

Biopsy follow-up in patients with atypical small acinar proliferation and prostate intraepithelial neoplasm in prostate biopsy

Loss of MyD88 leads to more aggressive TRAMP prostate cancer and influences tumor infiltrating lymphocytes.

The influence of pattern recognition receptor (PRR) signaling in the prostate tumor microenvironment remains unclear. Although there may be a role for PRR agonists as adjuvants to therapy, prior evidence suggests tumor promoting as well as tumor inhibiting mechanisms. The purpose of this study is to examine the role of the key Toll-like receptor (TLR) signaling adaptor protein myeloid differentiation primary response gene 88 (MyD88) in prostate cancer development. MyD88(-/-) mice in a C57Bl6 background were crossed with transgenic adenocarcinomas of the mouse prostate (TRAMP) mice to create MyD88(-/-) TRAMP(Tg+/-) animals, which were compared to MyD88(+/+) TRAMP(Tg+/-) animals and their non-transgenic counterparts at 30 weeks. Prostates were examined histologically, by immunohistochemistry and immunofluorescence staining, and by qPCR, to characterize tumor-infiltrating immune populations as well as activation of the downstream NF-κB pathway and androgen receptor (AR) expression. Splenocytes were examined for development of distinct immune cell populations. Absence of MyD88 led to increased prostatic intraepithelial neoplasm (PIN) and areas of well-differentiated adenocarcinoma in TRAMP transgenic mice. Analysis of infiltrating immune populations revealed an increase in CD11b(+) Gr1(+) myeloid-derived suppressor cells (MDSCs), as evidenced by increased expression of prostatic arginase-1 and iNOS as well as the cytokine IL-10, and a deficiency in NK cells in prostates from MyD88(-/-) TRAMP(Tg+/-) compared to MyD88(+/+) TRAMP(Tg+/-) mice, whereas a decrease in splenocytic NK cell differentiation was observed in MyD88(-/-) mice. Prostate tumors revealed no significant differences in NF-κB or AR expression in MyD88(+/+) TRAMP(Tg+/-) compared to MyD88(-/-) TRAMP(Tg+/-) mice. During prostate cancer development in the TRAMP model, MyD88 may play a role in limiting prostate tumorigenesis by altering tumor-infiltrating immune populations. This suggests that in the context of specific cancers, distinct PRRs and signaling pathways of innate immune signaling may influence the tumor microenvironment and represent a novel therapeutic strategy.

Evaluation of mucin histochemistry in benign and malignant prostatic lesion and their correlationPSA level

Background: The major causes of prostatic enlargement are nodular hyperplasia, prostatitis and neoplasm including prostatic intraepithelial neoplasm. Acidic mucin is absent in benign prostatic glands and is present in some prostatic adenocarcinomas. Mucin stain may be an adjunctive aid in the diagnosis of prostatic adenocarcinoma. This study aims to find out role of acidic mucin in differentiating benign and malignant lesion together with the aid of PSA level.Materials and Methods: A study was done from August 2006 to August 2008. Serum PSA level was performed. Biopsy specimen were processed and stained with Hematoxylin and Eosin as well as Alcian Blue and Periodic Acid Schiff. Data was coded and entered into SPSS v. 11 and Chi-square test and scatter plot was done to analyze the findings.Results: Out of 207 prostatic specimens studied, 78.3% showed BPH with or without prostatitis whereas 12% showed PIN and 8.7% malignancy. PSA density showed statistical significance with p= 0.02, in favor of malignancy. Alcian blue positivity was in 77.8% of malignant cases and 18.5 % in benign cases (p = 0.000003). Acid mucin was more in well differentiating tumours decreasing significantly in high grade malignancies. Combined diagnostic value of PSA&gt;10 ng/ml and Alcian blue positivity showed increase in specificity to 96.8% for diagnosing a malignant lesion, with positive predictive value of 57.1%.Conclusion: PSA density can be used to identify and pick up malignant cases where intermediate levels of PSA values are common. Alcian blue stain can help in assessing the degree of differentiation in malignant cases. DOI: http://dx.doi.org/10.3126/jpn.v4i8.11611 Journal of Pathology of Nepal; Vol.4,No8(2014) 612-616

Chronic inflammation of the prostate type IV with respect to risk of prostate cancer.

Chronic inflammatory infiltrate (CII) might be involved in prostate cancer (PCA) and benign hyperplasia (BPH); however, its significance is controversial. Chronic inflammatory prostatitis type IV is the most common non cancer diagnosis in men undergoing biopsy because of suspected PCA. To evaluate potential associations of coexistent CII and PCA in biopsy specimens after prostate assessment. Between January 2007 and December 2008, 415 consecutive patients who underwent prostate biopsy were retrospectively evaluated. The investigated variables included Age (years) and PSA (ug/l); moreover, CII+, glandular atrophy (GA+), glandular hyperplasia (GH+), prostate Intraepithelial neoplasm (PIN+), atypical small acinar cell proliferation (ASAP+) and PCA positive cores (P+) were evaluated as categorical and continuous (proportion of positive cores). Associations of CII+ and PCA risk were assessed by statistical methods. In the patient population, a biopsy core positive for PCA was detected in 34.2% of cases and the rate of high grade PCA (HGPCA: bGS ! 8) resulted 4.82%. CII+ significantly and inversely associated with a positive biopsy core P+ (P &lt; 0.0001; OR = 0.26) and HGPCA (P = 0.0005; OR = 0.05). Moreover, the associations indicated that patients with coexistent CII+ on needle biopsy were 74% less likely to have coexistent PCA than men without CII+ as well as 95% less likely to have HGPCA in the biopsy core than men without coexistent CII+. There were limits in our study which was single centre and included only one dedicated pathologist. There was an inverse association of chronic inflammation of the prostate type IV and risk of PCA; moreover, HGPCA was less likely to be detected in cancers associated with coexistent CII. In prostate microenvironment, prostate chronic inflammation may be protective; however, its role in PCA carcinogenesis remains controversial and needs further research.

Prostate cancer and new insights in angiogenesis.

Prostate cancer and new insights in angiogenesis.

The Impact of 5-Alpha Reductase Inhibitor vs. Alpha-1 Adrenergic Receptor Antagonists on Course of Prostate Premalignant Conditions

Prostate intraepithelial neoplasm and atypical small acinar proliferation are considered prostate premalignant conditions. Such a diagnosis impacts further follow-up significantly as early detection of prostate cancer is of utmost importance. alpha-1 adrenergic receptor antagonists (i.e. doxazosiunum) and inhibitors of 5-alpha reductase (Finasteride) showed some efficacy in prevention of prostate cancer development. To assess the impact of both above mentioned drugs on prostate premalignant conditions. From January 2008 till September 2012, 213 patients with one of the above mentioned premalignant condition were retrospectively evaluated. after diagnosis they were assigned to group 1 (n-126)- treated with Finasteride or to group 2 (n-87)-treated with doxazosinum. every 6-7 months rebiopsies were conducted in each patient. Rate of remission and progression was assessed. In comparison between group 1 and 2 the rate of remission was 35.7% (n-45) vs. 18.4% (n-16) (p = 0.005). In terms of progression, the difference between 1st and 2nd group of patients was 7.1% (n-9) vs. 5.7% (n-5) (p = 0.68). Remission of prostate premalignant condition is efficacious with Finasteride and not with doxazosinum. However, in terms of progression there were no differences among both drugs.

Significance of atypical small acinar proliferation and extensive high-grade prostatic intraepithelial neoplasm in clinical practice.

IntroductionProstate cancer (PCa) is one of the most commonly diagnosed neoplasms in elderly men. The precancerous lesion of PCa is considered a high-grade prostate intraepithelial neoplasm (HG-PIN), while atypical small acinar proliferation (ASAP) is commonly considered as an under-diagnosed cancer. The aim of the study was to establish the impact of ASAP and extensive HG-PIN on pre-biopsy prostate-specific antigen (PSA) levels and the risk of cancer development in subsequent biopseis.Material and methodsThe 1,010 men suspected for PCa were included in the study based on elevated PSA, and/or positive rectal examination. Transrectal ultrasound (TRUS) guided 10 core biopsy was performed. In those with extensive HG-PIN or ASAP on the first biopsy, and/or elevated PSA value, a second biopsy was performed.ResultsIn the second biopsy, PCa was diagnosed in 6 of 19 patients (31.57%) with extensive HG-PIN, in four of 40 (10%) with BPH, and in 4 of 18 (22.22%) with ASAP.There was a statistically significant difference between the values of PSA in the group of patients with ASAP in comparison to those with benign prostate hyperplasia (BPH) (p = 0.005) as well as in patients with HG-PIN in comparison to BPH (p = 0.02).ConclusionsA precancerous lesion diagnosed upon biopsy causes a statistically significant increase in the values of PSA in relation to BPH, as well as in the case of ASAP and extensive HG-PIN.The estimate of risk of PCa diagnosis in patients with ASAP and those with extensive HG-PIN in the first biopsy is comparable, which is why there are no reasons for different treatment of patients with the above-mentioned diagnoses. Both should be subjected to urgent second biopsy in around the 4-6 weeks following the initial biopsy.

Analysis of prostate needle biopsy in patients visiting B &amp; B hospital: a three year retrospective study

Background: Prostate cancer is the most common cancer in men. Prostate specifi c antigen is a key tumor marker to screen for prostate cancer. However, controversy exits regarding the impact of prostate cancer screening. Materials and Methods: This was a retrospective study carried out in the Department of Histopathology of B and B Hospital during a period of 2 years from 01-05-2064 to 01-05-2066. The study included 26 cases of prostate needle biopsy specimens. Results: The more common age group (43.9%) was 70-79 years followed by the age group above 80 years old (7.5%). The most common benign lesion observed was benign prostatic hyperplasia (5 out of 11, 45.45%), followed by benign prostatic hyperplasia with chronic prostatitis (3 out of 11, 27.27%). The most common malignant types of lesion encountered was prostatic adenocarcinoma with an incidence of 84.62% (11 out of 13 cases), following nodular hyperplasia of prostate with low grade prostatic intraepithelial neoplasm 15.38% (2 out of 13 cases). Among the benign and the malignant cases serum PSA ranged from 0 - ?10.1 ng/ml. Conclusion: Serum PSA value has signifi cant role in the diagnosis of malignant prostatic lesions. However, Histological diagnosis still remains the gold standard for the diagnosis of prostatic cancer. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 394-396 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7865

Does Positive Family History of Prostate Cancer Increase the Risk of Prostate Cancer on Initial Prostate Biopsy?

To assess the role of family history (FH) in the risk of a positive prostate biopsy (PBx) in a large North American biopsy population as earlier reports showed increased risk of prostate cancer (PCa) in men with a FH, but the risk has been limited to low grade prostate cancer in smaller studies, and the REDUCE trial found no such risk in North American patients. We evaluated 4360 men undergoing initial extended biopsy (8-14 cores). Indications were elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Variables including age, FH of PCa, race, PSA, and DRE results were included in our analysis to assess risk factors associated with PCa, high-grade prostate cancer (HGPCa), and low-grade prostate cancer (LGPCa). Two hundred sixty-eight patients had an FH of PCa whereas 4092 had negative FH. Positive biopsy was found in 1976 patients with HGPCa in 1149 and LGPCa in 827. Among 268 patients with an FH, overall PCa was found in 144 of 268 patients (54%); HGPCa in 79 of 144 patients (55%) and LGPCa in 65 of 144 patients (45%). FH was a significant risk factor for PCa, HGPCa, and LGPCa in univariate and multivariate analysis (P= .0001, .02, and .02, respectively). Also, FH was associated with high-risk benign pathology in the form of atypical small acinar cell proliferation (ASAP) or high-grade prostatic intraepithelial neoplasm (HGPIN) (P= .04). Men in North America with an FH of PCa who undergo prostate biopsy are more likely to be diagnosed with both HGPCa and LGPCa.

Conditional Deletion of the Pten Gene in the Mouse Prostate Induces Prostatic Intraepithelial Neoplasms at Early Ages but a Slow Progression to Prostate Tumors

The PTEN tumor suppressor gene is frequently inactivated in human prostate cancer. Using Osr1 (odd skipped related 1)-Cre mice, we generated a novel conditional Pten knockout mouse strain, PtenLoxP:Osr1-Cre. Conditional biallelic and monoallelic Pten knockout mice were viable. Deletion of Pten expression was detected in the prostate of PtenLoxP/LoxP:Osr1-Cre mice as early as 2 weeks of age. Intriguingly, PtenLoxP/LoxP:Osr1-Cre mice develop high-grade prostatic intraepithelial neoplasms (PINs) with high penetrance as early as one-month of age, and locally invasive prostatic tumors after 12-months of age. PtenLoxP/+:Osr1-Cre mice show only mild oncogenic changes after 8-weeks of age. Castration of PtenLoxP/LoxP:Osr1-Cre mice shows no significant regression of prostate tumors, although a shift of androgen receptor (AR) staining from the nuclei to cytoplasm is observed in Pten null tumor cells of castrated mice. Enhanced Akt activity is observed in Pten null tumor cells of castrated PtenLoxP/LoxP:Osr1-Cre. This study provides a novel mouse model that can be used to investigate a primary role of Pten in initiating oncogenic transformation in the prostate and to examine other genetic and epigenetic changes that are required for tumor progression in the mouse prostate.

Prostatic tumours among Nigerian males: A private practice experience in Benin-City, South-South, Nigeria

To highlight the frequency and histological types of prostatic tumours seen in a private practice setting in Benin-City, South-South Nigeria. Haematoxylin and eosin stained-slides of prostatic biopsies diagnosed at the Ashamas Foundation Diagnostic Centre, Benin-City for 10 years were archived and studied. Histological request forms were analysed for clinical bio-data, type of biopsies and diagnosis. A total of 908 prostatic tumours comprising of 468 open prostatectomies, 378 transurethral prostatectomies, 60 needle biopsies and 2 unspecified biopsy types were diagnosed. The peak age incidence of prostatic tumours was 60-69 years accounting for 37% of all prostatic tumours. Nodular prostatic hyperplasia (NPH) was the most common tumour accounting for 74.9%. Prostatic cancer was the second most common tumour accounting for 22.1% of all prostatic tumours. Six cases (1.3%) of incidental carcinoma were diagnosed out of the 680 cases of NPH. Transitional cell carcinoma and metastatic carcinoma constituted 0.2%, 0.1% of prostatic tumours respectively. In all, carcinosarcoma and fibrosarcoma accounted for 0.1% each of the prostatic tumours. High grade prostatic intraepithelial neoplasm accounted for 0.2% while 1.1% was inadequate for histopathological diagnosis. Nodular prostatic hyperplasia accounted for vast majority of all prostatic tumours in this study. However a significant percentage of prostatic adenocarcinoma was also encountered. Health education and population based screening modalities are advocated to reduce prostatic tumour morbidity and mortality in the Nigerian adult male population.