Relation of Serum Prostate-Specific Antigen with Histological Features and Grading of Prostate Adenocarcinoma in Prostatic Biopsies

Abstract

Introduction: The present study was undertaken on cases of prostate carcinoma and we tried to determine the relationship of elevated prostate specific antigen (PSA) level to histopathologic features associated with cancer in prostate biopsies and their relation to newest grade groups. Materials and Methods: The study was conducted in a tertiary health care center over a span of 3 years on patients with prostatic adenocarcinoma. The hematoxylin and eosin sections were reviewed as per World Health Organization 2016 new grading system and various other associated histopathological findings in the tissue noted. We tried to analyse correlation between serum PSA levels and histopathological features. Results: The majority of patients were in the age group of 70–80. Many patients (9/44) had the PSA in the range of 20–40 ng/ml and 10 patients (22.7%) had 80–100 ng/ml. There were three patients with normal PSA level and six patients with borderline level. Nine of 10 patients with marked increase in PSA level had higher grade groups. Histological subtyping showed 42 cases of acinar adenocarcinoma and 2 cases of ductal carcinoma. A number of associated findings were seen like benign prostatic hyperplasia (BPH): 13 cases, prostatitis: 28 cases, prostatic intraepithelial neoplasia: 7 cases - Low grade (1 case) and high grade (6 cases), and atrophy: 9 cases. Conclusions: We noticed majority of patients with grade group (GG) 3 and above had PSA value of more than 40 ng/ml, but PSA of <40 ng/ml did not correlate with the histologic grade groups. There was significant cut off value of PSA level 20 ng/ml between GG2 and GG3, differentiation of which is of clinical and histopathological significance. Histological subtyping showed acinar adenocarcinoma has no significant correlation with PSA levels however ductal carcinoma was associated with PSA levels <20 ng/ml. BPH association was seen to have PSA level of <40 ng/ml in majority of cases. The intensity of inflammation did not correlate with either degree of PSA level or histologic GG. We concluded serum PSA assay has prognostic application in the evaluation of patients undergoing prostate biopsies.

Keywords

Associated histological features - carcinoma prostate - Gleason’s grading - serum prostate-specific antigen

• References

• 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66: 7-30
• 2 Andriole GL, Crawford ED, Grubb 3rd RL, Buys SS, Chia D, Church TR. et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up. J Natl Cancer Inst 2012; 104: 125-32
• 3 Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V. et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012; 366: 981-90
• 4 Moch H, Humphrey PA, Ulbright TM, Reuter V. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Lyon, France: International Agency for Research on Cancer; 2016
• 5 Rosai J, Ackerman L. Surgical Pathology. 11th ed. New York: Mosby; 2017
• 6 Jose L, Suma MT, Sadasivan S, Souda VM. Gleason’s grading of carcinoma prostate with PSA correlation. J Med Sc Clin Res 2017; 5: 27634-9
• 7 Abu Farsakh MG, Abu Farsakh HA. Serum prostate-specific antigen, radiologic findings and Gleason score in prostate biopsies in Jordan. Hematol Oncol Stem Cell Ther 2008; 1: 171-4
• 8 Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS. et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177: 2106-31
• 9 Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: Definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 2016; 40: 244-52
• 10 Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C. et al. A contemporary prostate cancer grading system: A validated alternative to the Gleason score. Eur Urol 2016; 69: 428-35
• 11 Packiam VT, Patel SG, Pariser JJ, Richards KA, Weiner AB, Paner GP. et al. Contemporary population-based comparison of localized ductal adenocarcinoma and high-risk Acinar adenocarcinoma of the prostate. Urology 2015; 86: 777-82
• 12 Bostwick DG, Cooner WH, Denis L, Jones GW, Scardino PT, Murphy GP. The association of benign prostatic hyperplasia and cancer of the prostate. Cancer 1992; 70: 291-301
• 13 Yeboah ED, Hsing AW. Benign prostatic hyperplasia and prostate cancer in Africans and Africans in the diaspora. J West Afr Coll Surg 2016; 6: x-xviii
• 14 Alcaraz A, Hammerer P, Tubaro A, Schröder FH, Castro R. Editorial comment on: Is there evidence of a relationship between benign prostatic hyperpl Asia and prostate cancer? Findings of a literature review. Eur Urol 2009; 55: 873-4
• 15 Sfanos KS, De Marzo AM. Prostate cancer and inflammation: The evidence. Histopathology 2012; 60: 199-215
• 16 Ronnett BM, Carmichael MJ, Carter HB, Epstein JI. Does high grade prostatic intraepithelial neoplasia result in elevated serum prostate specific antigen levels?. J Urol 1993; 150: 386-9
• 17 Haffner MC, Weier C, Xu MM, Vaghasia A, Gürel B, Gümüşkaya B. et al. Molecular evidence that invasive adenocarcinoma can mimic prostatic intraepithelial neoplasia (PIN) and intraductal carcinoma through retrograde glandular colonization. J Pathol 2016; 238: 31-41
• 18 Billis A, Meirelles LR, Magna LA, Baracat J, Prando A, Ferreira U. Extent of prostatic atrophy in needle biopsies and serum PSA levels: Is there an association?. Urology 2007; 69: 927-30
• 19 De Marzo AM, Platz EA, Sutcliffe S, Xu J, Grönberg H, Drake CG. et al. Inflammation in prostate carcinogenesis. Nat Rev Cancer 2007; 7: 256-69