Prostate-specific Antigen Staining Research Articles

Paget's disease primarily involving the scrotum

Three cases of Paget's disease primarily involving the scrotum are reported. One case exhibited positive staining for prostate specific antigen (PSA) and was associated with an underlying, invasive poorly differentiated adenocarcinoma of unknown primary. The other cases were not associated with any underlying or visceral malignancy. The literature on Paget's disease primarily involving the scrotum including clinical presentation, differential diagnosis, treatment, prognosis, and possible histogenetic mechanisms of this disease is discussed.

Correlation of prostate-specific acid phosphatase and prostate-specific antigen immunocytochemistry with survival in prostate carcinoma

Prostate-specific acid phosphatase, a secretory product of prostatic cells, may be a secondary product of the interaction of hormones with their receptor proteins. In this study we have examined two independent patient populations to see whether the intensity or extent of prostate-specific acid phosphatase and/or prostate-specific antigen staining correlated with survival and hormonal manipulation. One population of 24 patients was selected from patients undergoing surgical resection for adenocarcinoma Stage B or C at the Mayo Clinic. The second population of 123 patients was obtained from Radiation Therapy Oncology Group Protocols 75-06 and 77-06. Tissue from both populations was analyzed. In both populations, the intensity of prostate-specific acid phosphatase staining correlated with survival in a statistically significant manner. Staining with prostate-specific antigen was present in greater than 90% of specimens; data was therefore not analyzed. In those patients who subsequently relapsed and were subjected to hormonal manipulation, there appeared to be a higher likelihood of response to hormones with intense prostate-specific acid phosphatase staining.

Immunohistochemical Evidence for Impaired Cell Differentiation in the Premalignant Phase of Prostate Carcinogenesis

Epithelial cell differentiation was evaluated in 15 samples of duct-acinar dysplasia, a putative premalignant lesion of the prostate, through immunohistochemical staining for five differentiation markers. Prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), Leu-7, pepsinogen II (PG II), and tissue plasminogen activator (t-PA) are all constituents of seminal fluid that are produced by prostatic epithelium. Dysplasia foci were classified into three grades of severity and their locations mapped by camera lucida drawings of each slide. The degree of abnormal staining with each antibody was recorded on the map, and its correlation with dysplasia grade was evaluated. PSA, PAP, and Leu-7 staining were reduced in dysplasia and often absent in severe dysplasia, indicating that reduced differentiation is an early change in prostatic carcinogenesis. PG II and t-PA stains were sometimes positive in a region where they are usually absent, suggesting that deregulation of differentiation markers may accompany reduction in differentiation in these preneoplastic lesions.

The Response of Poorly Differentiated Prostatic Tumors to Staining for Prostate Specific Antigen and Prostatic Acid Phosphatase: A Comparative Study

A comparative study was done of the usefulness of immunohistochemical stains for prostate specific antigen and prostatic acid phosphatase in 20 poorly differentiated prostatic tumors. The stain for prostatic acid phosphatase was preferable to the prostate specific antigen stain not only because it was more intense and, therefore, more visible but also because it often was positive in areas in which an equivocal or negative stain was obtained with prostate specific antigen.

Anti‐Leu 7 immunoreactivity with human tumours: its value in the diagnosis of prostatic adenocarcinoma

The reactivity of the anti-Leu 7 monoclonal antibody (Leu 7) was tested on 83 human tumours and on non-neoplastic prostatic, hepatic and pancreatic tissues. A four-step peroxidase-anti-peroxidase method was used on paraffin embedded tissues and we observed strong cytoplasmic positivity in all 19 primary prostatic tumours, in two metastatic, poorly differentiated prostatic adenocarcinomas, and in normal and hypertrophic prostatic epithelium. All the primary prostatic tumours also stained positively for prostate-specific antigen and for prostatic acid phosphatase using polyclonal antisera. The degree of positivity for these antigens varied from case to case. Adenocarcinomas arising from the gastrointestinal tract, pancreas and gallbladder were anti-Leu 7 negative. Focal Leu 7 positivity, largely confined to cell membranes, was observed in some ovarian, endometrial, renal, lung and breast adenocarcinomas. These tumours, as well as some of the gastrointestinal, hepatic and pancreatic tumours, also showed focal cytoplasmic positivity for prostate-specific antigen and prostatic acid phosphatase. Our findings suggest that the anti-Leu 7 monoclonal antibody is a marker that may facilitate the detection of metastatic prostatic adenocarcinoma, especially when used in conjunction with staining for prostate-specific antigen.

Invasive carcinoma of prostate presenting as rectal carcinoma

Prostate carcinoma occasionally can present with rectal obstructive symptoms and an annular constricting lesion of the rectum. Discriminating between primary rectal carcinoma and prostate carcinoma locally invasive to the rectum is of obvious importance because of the different treatments and prognoses. History and physical examination play only a marginal role in differentiating between these two lesions. The diagnosis of prostatic malignancy in patients in this circumstance can be supported by an elevated serum acid phosphatase as well as a bone scan that demonstrates a pelvic/vertebral distribution of bony metastases. The rectal mucosa is usually spared, and a barium enema often will demonstrate tapered margins as opposed to a tumor edge in primary rectal malignancy. Excretory urography often demonstrates hydronephrosis. Rectal biopsy with immunohistochemical staining for prostate specific antigen can direct the origin of a poorly differentiated adenocarcinoma to the prostate. Treatment involves hormonal manipulation with estrogen therapy or orchiectomy. Radiation therapy to the obstructed rectum has provided satisfactory palliation when hormonal manipulation fails.

Prostatic carcinoma metastatic to bone: Sensitivity and specificity of prostate‐specific antigen and prostatic acid phosphatase in decalcified material

Decalcified bone marrow biopsies containing metastatic tumor from 36 patients were stained for prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) using the avidin biotin complex (ABC) immunoperoxidase technique. Of these patients, 22 had known prostate primaries, ten had known nonprostatic, and four female patients had unknown primaries. Prostate-specific antigen was identified in 86% (19/22) of the metastatic prostatic carcinomas. Prostatic acid phosphatase was present in only 36% (8/22). None of the patients with nonprostatic primaries or unknown primaries showed positive staining for either antigen (0/14). This study indicates that immunoperoxidase staining for PSA is very sensitive and specific in the diagnosis of metastatic prostate carcinoma, while PAP was less sensitive using decalcified bone marrow specimens. We believe that immunostaining with PSA should be of great value in diagnosis of prostatic carcinoma metastatic to the bone.

Immunohistochemical Diagnosis of the Metastasizing Prostatic Carcinoma

Metastases of 47 known prostatic carcinomas were subjected to the unlabeled immunoperoxidase procedure to localize prostate acid phosphatase (PAP) and prostate-specific antigen (PSA). PAP was found in 64% and PSA in 78% of bone marrow, lymph node, lung and liver metastases investigated. There was no significant difference between the intensity of staining in primary and metastatic neoplasms. Staining of PAP and PSA was found to be less intense in poorly differentiated metastases of prostatic adenocarcinomas. The data suggest that the demonstration of PAP and PSA is a practical and sensitive test for determining the prostatic origin of a clinically and histologically unclassifiable metastasis.

Role of immunocytochemistry in diagnosis of prostatic neoplasia by fine needle aspiration biopsy

The efficacy of immunocytochemical staining for prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) was studied in aspiration biopsy specimens from 19 patients. Eighteen patients had prostatic carcinoma and one had hyperplasia of prostate. Specimens were obtained from both the primary tumors and metastatic sites. Immunoperoxidase staining was performed on alcohol-fixed cytology smears (some prepared up to 9 years previously) using appropriate antisera followed by an avidin-biotinylated horseradish peroxidase complex. Results were scored according to the percentage and intensity of positively stained malignant cells. Corresponding histologic specimens were stained and scored in a similar fashion. Correlations were made between the staining characteristics of the tumor markers and grade of tumor, using the University of Texas M.D. Anderson Hospital classification of prostate carcinoma. Overall there was good correlation between cytologic and histologic specimens for the presence of PSA and PSAP, although metastases tended to show fewer positively stained cells than the primary tumor. There was no relationship between tumor grade and percentage of positively stained cells. Ninety-three percent of aspirated primary and secondary prostatic tumors stained positively for PSAP compared with 81% for PSA. In one of 3 patients, negative staining of neoplastic cells by both PSAP and PSA was helpful in confirming the existence of a second primary tumor.

Immunoperoxidase localization of prostatic antigens: Comparison of primary and metastatic sites

Immunoperoxidase staining for prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) help to identify patients with prostatic carcinoma presenting as metastatic disease from an occult primary source. To clarify further the reliability of these prostatic tissue antigens, we have examined the primary tumor and metastatic sites in 16 autopsy cases. Eleven of these had diffusely positive findings for PSA and PAP in the primary and all metastatic sites, and 1 case lacked both antigens in all locations. Four cases demonstrated variability between these antigens and among various sites. Prostatic primary lesions contained PAP and PSA in 13 (81%) and 12 (75%) cases, respectively. The most reliable metastatic sites were lymph nodes, seminal vesicles, lung, bone, and kidney; while liver, adrenal, and colorectal sites were less reliable. No relationship existed between serum PAP levels and tissue detectability of PAP. The use of both PAP and PSA increases the likelihood of properly identifying the prostate as the organ of origin of metastatic disease. In spite of the use of both markers, however, three primary lesions would have been misdiagnosed, and 1 case lacked both antigens in all metastatic sites as well. In poorly differentiated lesions, the lack of both antigens does not unequivocally eliminate the possibility of prostatic carcinoma.

Multiple Immunoperoxidase Markers in Benign Hyperplasia and Adenocarcinoma of the Prostate

A series of 60 cases of prostatic adenocarcinoma and 34 cases of benign prostatic hyperplasia were examined quantitatively after immunoperoxidase staining for prostate-specific antigen (PSA), prostate-specific acid phosphatase (PSAP), carcino-embryonic antigen (CEA), epithelial membrane antigen (EMA), alpha fetoprotein (AFP), and human chorionic gonadotrophs (HCC). The tumors were graded I to IV according to the MDAH grading system recently proposed. Fifty-nine of the 60 tumors were positive for PSA and 58 were positive for PSAP. The one PSA and PSAP negative case was CEA negative and weakly EMA positive. Grade I to III tumors stained more tumor cells and more diffusely for PSA and PSAP than grade IV tumors. There was no significant difference in the intensity or extent of staining between grade I and grade II–III tumors for PSA and PSAP. A comparison of PSA and PSAP showed that PSA stained more intensely and more extensively than PSAP. Benign prostatic tissue and low-grade prostatic tumors did not stain for CEA but three of the 20 grade IV tumors and one of the 23 grade II–III tumors did. Staining for EMA was focal and showed no relation to tumor grade. Benign and malignant lesions failed to stain for AFP and HCG.

TESTICULAR METASTASIS FROM CARCINOMA OF PROSTATE

Metastatic involvement of the testis from prostatic carcinoma is rare. We report a case discovered at 5 years after orchiectomy by immunohistochemical staining of prostate specific antigen. The clinical application of this specific method of stainig on metastatic carcinoma of the prostate and a review of the literature on secondary testicular tumors are presented.

Evaluation of Prostate Specific Acid Phosphatase and Prostate Specific Antigen in Identification of Prostatic Cancer

The peroxidase-anti-peroxidase technique was used to stain for prostate specific acid phosphatase and prostate specific antigen in 12 patients with primary tumors and in 12 patients with metastases in whom the nature of the tumor was in doubt after routine histopathological studies. Nine of the primary tumors were positive for both markers and an additional 2 tumors stained for prostate specific antigen only. Six metastatic lesions stained for both markers and a seventh for prostate specific antigen alone. Thus, 11 of 12 primary tumors and 7 of 12 metastases studied were proved to be of prostatic orgin. While the peroxidase staining was sometimes weak and uneven this method, using prostate specific antigen and prostate specific acid phosphatase, allowed for ready identification of metastases. The heterogeneity of the tumors in regard to these 2 prostate markers is demonstrated, and the value of staining for prostate specific acid phosphatase and prostate specific antigen is emphasized.

Immunoperoxidase localization of prostate-specific antigen.

In instances of metastatic tumor from an unknown primary site, it is important to isolate those cases which are attributable to prostatic carcinoma. Immunoperoxidase localization of human prostate-specific antigen (PSA) would be useful in this regard if it were reliably detectable in prostatic carcinoma. We have studied 15 specimens from 14 patients with carcinoma of the prostate by immunoperoxidase techniques. The presence of PSA correlates with the Gleason grade. All cases of Gleason grade 9 or less demonstrated strong staining for PSA. Of the seven specimens with a Gleason grade 10, only four (57%) demonstrated significant staining, while two were entirely devoid of PSA. PSA is thus useful when it is present, but the absence of PSA in a poorly differentiated tumor of undetermined origin does not unequivocally rule out the possibility of a prostatic carcinoma.