Prospective evaluation of AMACR (P504S) and basal cell markers in the assessment of routine prostate needle biopsy specimens

Use of Immunohistochemistry in Routine Workup of Prostate Needle Biopsies: A Tertiary Academic Institution Experience

“…This is higher than the previously reported rate of 22% for IHC used in prostate needle biopsies in a prospective study of a similar duration (7 months) and volume (772 cases), performed in a tertiary institution, but with a primary focus to evaluate the diagnostic value of IHC for AMACR. 11 It was encouraging that the use of IHC did not markedly extend the turnaround time for prostate biopsies in our practice, resulting in an acceptable 1.7-day delay for the biopsy signout. No major differences were seen in the frequency and the pattern of IHC use among individual pathologists, analyzing the diagnostic biopsy breakdown, which indicated similar use of IHC among the pathologists in the workup of prostate needle biopsies.…”

“…At an estimated cost of $31.00 per immunostain, the average COMMENT The diagnostic utility of HMWK and AMACR have been evaluated extensively in the prostate pathology practice from a diagnostic perspective, but the quality assurance and the cost aspects of the use of IHC in evaluating prostate needle biopsies, a large segment of genitourinary pathology practice, to our knowledge have not been previously addressed. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] It is uncertain, for example, how much IHC is used in routine prostate biopsy practice; what is the appropriate level of IHC use, both from diagnostic and quality assurance purposes; what is the breakdown of the final diagnostic decisions when IHC is used; what are the implications for additional departmental consultations; and what are the associated costs of the use of IHC? Some of these issues, such as the level and the suitability of IHC use in evaluating prostate needle biopsies, are obviously influenced by additional factors, including the type of practice (academic/teaching versus private; general versus specialized; community versus consult), pathologist's level of experience, expertise, and the volume of prostate biopsy material seen, as well as the quality of the produced slides, which may be dependent on the tissue fixation, the thickness of the sections, and the staining quality of the slides.…”

“…We did not use spare unstained slides between the initial H&E levels/slides, though we were aware that this approach was practiced by some. 5,11 In our experience, the initial cutting of additional unstained slides generated many slides that were never used, resulting in added costs for slide production and storage. In our practice, the biopsies were reported using a synoptic template, with each specimen from the specific prostate location having a separate diagnostic line; a summary of the findings was also included at the end of the report.…”

“…The use of IHC for highmolecular-weight keratin (HMWK) and a-methylacyl coenzyme A racemase (AMACR), either individually or in combination, has been studied extensively in prostate pathology practice, primarily as a tool in confirming and establishing cancer diagnosis on prostate needle biopsy and for evaluating challenging and questionable foci in prostate specimens, particularly on needle biopsy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In addition, IHC use has risen for the evaluation of prostate needle biopsies because its use in conjunction with morphology is critical to prevent diagnostic errors, especially diagnostic overcalls that may lead to unnecessary radical prostatectomy. Indeed, the use of IHC in prostate biopsy has shown an upward trend over time.…”

TEAD1 and c-Cbl are novel prostate basal cell markers that correlate with poor clinical outcome in prostate cancer

“…Changes in the balance between epithelial cell division and differentiation may play a key role in the development of both prostate cancer and benign prostatic hyperplasia (BPH) (Bonkhoff and Remberger, 1996). Prostate cancer cells resemble those of the luminal layer (Browne et al, 2004), particularly in their expression of prostate-specific antigen (PSA) and the androgen receptor (AR). Unlike luminal cells, however, and in common with basal cells, cancer cells maintain the ability to proliferate.…”