The Clinical Implication of Incidental Prostatic Amyloidosis

Nevo, Amihay; Muchtar, Eli; Stern, Karen; Moore, Jonathan P.; Cheney, Scott; Humphreys, Mitchell R.; Grogan, Martha; Stanton, Melissa L.

doi:10.1016/j.urology.2020.08.053

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…Our observations are consistent with previous reports in the literature 34,41 suggesting that the prostate is a target tissue for TTR‐amyloid deposition, and that amyloid deposits can be detected in the prostate before the onset of more threatening involvement such as cardiac amyloidosis. With the growing number of screening biopsies in younger patients, awareness of this finding among pathologists could increase rates of early detection of the disease which, in time, could affect future treatment and management of these patients by multidisciplinary teams.…”

Section: Discussionsupporting

confidence: 93%

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Clinical relevance of amyloid in prostate samples: a report on 40 patients

et al. 2022

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Objective To describe the clinical findings in patients with incidental prostatic amyloidosis. Patients and methods Retrospective search in the database of the Department of Pathology, Hospital de Bellvitge, for prostate specimens with amyloid. Congo red and immunohistochemical staining of the sections. Review of the patients’ clinical charts for symptoms attributable to systemic amyloidosis. Results Amyloid deposition in the prostate was identified and reported in 40 patients between 2001 and 2022. Median age was 76.5 years (range = 62–90 years). Prostate cancer was diagnosed in 25 patients. Only four patients had a previous diagnosis of amyloidosis. In the remaining 36 the prostate sample (31 needle biopsies, two transurethral resections (TUR), two simple prostatectomies, one radical cystectomy for bladder cancer) provided the initial diagnosis. Amyloid deposits were mainly located in the wall of small vessels and rarely in the prostatic stroma. Immunohistochemistry was available in 32 cases, 26 of which were positive for TTR. All patients showed at least one symptom indicative of systemic amyloidosis, the most frequent being hearing loss (55%), carpal tunnel syndrome (42,5%) or other osteoarticular symptoms (tendinopathies, osteoarthritis), cataracts (37.5%) and cardiac symptoms (32.5%), among others. Conclusion The prostate is a target tissue for amyloid deposition. The incidental finding of amyloid in prostate corresponds, in the majority of cases, to previously undiagnosed systemic TTR amyloidosis in patients lacking signs of heart involvement but having mainly osteoarticular symptoms, hearing and visual impairment.

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Section: Discussionsupporting

confidence: 93%

“…Wilson described a series of 10 cases of unsuspected amyloidosis in the prostate. Recently, another paper described the findings in prostate biopsies of seven patients with amyloid deposition in the prostate 41 . To date, to our knowledge, our series is the largest.…”

Section: Discussionmentioning

confidence: 88%

Clinical relevance of amyloid in prostate samples: a report on 40 patients

et al. 2022

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“…A recent review describing six patients with incidentally discovered prostatic ATTR amyloidosis indicated that five of the six patients also had or subsequently developed cardiac amyloidosis, suggesting that a thorough cardiac work-up is particularly important to perform in these patients. 8 In AL and AA amyloidosis, treatment is usually aimed at addressing the underlying plasma cell dyscrasia (AL) or the underlying inflammatory disorder (AA). Unfortunately, treatment options for wild-type ATTR amyloidosis are limited and the prognosis is poor.…”

Section: Discussionmentioning

confidence: 99%

“…5 Amyloidosis of the prostate is exceptionally rare, with only a handful of cases reported in the literature. [6][7][8] We report here a case of wild-type ATTR amyloidosis of the prostate discovered incidentally following radical prostatectomy.…”

Section: Introductionmentioning

confidence: 94%

Wild-type ATTR amyloidosis of the prostate: a case review

Sterrett

McCurdy

2021

Journal of Clinical Urology

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The amyloidoses are a rare group of disorders caused by the deposition of amyloid fibrils in organ tissues. Transthyretin-mediated amyloidosis is a subcategory of amyloidosis, which can be further subdivided into hereditary transthyretin-mediated or wild-type (‘senile’) amyloidosis. Involvement of the prostate by any type of amyloidosis is rare, with only a handful of cases reported in the literature. We report here a case of a 64-year-old Caucasian man who was incidentally found to have wild-type transthyretin-mediated amyloidosis of the prostate following a radical prostatectomy for treatment of a localised, Gleason 7 (4 + 3) adenocarcinoma of the prostate. TTR subtyping was confirmed by mass spectrometry. His family history was negative for known amyloidosis, and sequencing of the entire TTR gene was negative for any mutations, so he was therefore considered to have wild-type TTR amyloidosis. He was subsequently found to have additional foci of amyloid deposition in the gastrointestinal tract. Wild-type transthyretin-mediated amyloidosis as an incidental finding in a prostate biopsy is an extremely rare finding. Treatment options for transthyretin-mediated amyloidosis are limited, and further research and treatment options are needed in this rare and difficult to manage disease. Level of evidence: The level of evidence according to the Oxford Centre of Evidence-based Medicine levels of evidence is not applicable to this case report. Given that this is a rare entity, decisions made in managing this case were based on a level of evidence of 5.

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“…The use of the term amyloidosis is widely used throughout many publications in relation to many diseases and care must be taken to determine the precursor protein type. The incidental findings of prostatic amyloid transthyretin refers to cardiac amyloidosis [104], as opposed to the serum amyloid A [101][102][103]. Amyloidosis results from the accumulation of pathogenic amyloid, most of which are aggregates of misfolded proteins in a variety of tissues, which interferes with their normal physiology and function in chronic inflammatory diseases [103,[105][106][107][108][109][110].…”

Section: Amyloidosismentioning

confidence: 99%

The Etiology and Pathophysiology Genesis of Benign Prostatic Hyperplasia and Prostate Cancer: A New Perspective

Phua

2021

Medicines

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Background: The etiology of benign prostatic hyperplasia and prostate cancer are unknown, with ageing being the greatness risk factor. Methods: This new perspective evaluates the available interdisciplinary evidence regarding prostate ageing in terms of the cell biology of regulation and homeostasis, which could explain the timeline of evolutionary cancer biology as degenerative, inflammatory and neoplasm progressions in these multifactorial and heterogeneous prostatic diseases. Results: This prostate ageing degeneration hypothesis encompasses the testosterone-vascular-inflamm-ageing triad, along with the cell biology regulation of amyloidosis and autophagy within an evolutionary tumorigenesis microenvironment. Conclusions: An understanding of these biological processes of prostate ageing can provide potential strategies for early prevention and could contribute to maintaining quality of life for the ageing individual along with substantial medical cost savings.

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The Clinical Implication of Incidental Prostatic Amyloidosis

Cited by 8 publications

References 14 publications

Clinical relevance of amyloid in prostate samples: a report on 40 patients

Clinical relevance of amyloid in prostate samples: a report on 40 patients

Wild-type ATTR amyloidosis of the prostate: a case review

The Etiology and Pathophysiology Genesis of Benign Prostatic Hyperplasia and Prostate Cancer: A New Perspective

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