help understanding biopsy report

Here is my opinion as layman
Perineum

The best place to get answers to your questions is at the office of your doctor. He can explain to you in a “patient talk” manner for you to understand. However the final diagnoses of your status is more important to know, which will include factors other than the contents of your biopsy report.

Here is my opinion as layman on your questions, in simple words;

1)The core indicates benign cells with chronic inflammation which can be taken as Benign Prostatic Hyperplasia (BPH), an enlargement of the prostate.
2)The staining (test contrast colouring) indicates that the cells could have multiple classification (it could be benign, BPH, cancerous, etc).
3)The pathologist recommend additional testing using a colouring (reactive ink) of the type that can provide details of any interaction between the nervous system and the endocrine system. Probably to find a cause of the inflammation/hyperplasia.

Hope this helps.
VGama

Perineum said:

Thanks VascodaGama !
Hi,


Can you please explain the 3rd answer - "Probably to find a cause of the inflammation/hyperplasia".

- Is this test relates to the cancer? Can it reveal more info about its characteristics?
- It says "chronic inflammation" - why my urologists don't treat it? Is it dangerous?
- What are the possible causes to inflammation/hyperplasia?

Thanks VascodaGama !!

A probability of carcinoma
Hi Perineum

Do not be anxious. Discuss your concerns with your doctor and get strait answers, particularly in regards to your status (clinical stage, etc).

The inflammation of prostate has been related to a malignancy of prostatic basal cells. These are not cancerous but are not normal too. They grow and cause an enlargement of the prostate (hyperplasia) which narrows the pipe (urethra) constraining the normal flow of urine. The irritation will lead to infections causing pain when urinating.
The treatment for these cases usually is done with a dose of antibiotics and drugs to reduce the size/volume of the prostate.

When analyzing the cores of a biopsy, doctors look for the characteristics of the cells, identifying all the existing types and if they are benign or cancerous or “defected” due to other causes. They try to find a cause of your disease/diagnosis. The majority of “defected” cells have been related to hyperplasia.

In the analysis of your biopsy the pathologist did the “extra mile” and recommended an additional test (Immunohistochemical staining test) to check for the presence of Neuro-endocrine cells which are one of the various cells in the prostate and can be cancerous (similar to Small Cell Carcinoma) that coexists with adenocarcinomas (the most typical cancer of the prostate). These prostatic cells (NE) are not treatable with the usual hormonal therapy because they have no HT receptors. One could consider this guy a responsible serious doctor.

In his comment he is questioning if;
Are those cells truthfully related to hyperplasia or is there any probability of carcinomas (cancer)?

The Immunohistochemical staining can identify markers/enzymes which are known to be related to inflammations. In some studies it has been reported that one neuro-endocrine marker called “epidermal growth factor receptor” (EGFR) is present in several types of cancers (including prostate cancer). If the staining test is positive to EGFR then cancer may exist (as must as a PSA would identify an adenocarcinoma), even if those cells do not qualify under the Gleason Pattern scale. They would have a probability of becoming a recurrence PCa but as refractory prostate cancer (not sensitive to hormonal therapy).
You need to investigate in more detail the above, because if that test is positive, you may have a rare prostate cancer case.

Hope my insight answers your quest.
VGama

NOTE: I have edited this post to call to the attention of those interested in matters related to CARCINOMAS. The prostate gland is composed of several types of cells. When those become cancerous they proliferate and metastasize in the form of various types of cancer. The initiator of prostate cancer is called “prostatic intraepithelial neoplasia”, but the majority (around 95%) of cancer is of the type known as adenocarcinoma. This has become synonymous with the term “prostate cancer”.

Here is a site with a list of types of prostate cancer and their markers;
http://csn.cancer.org/node/211951

From another article on types of cancer of the prostate;
“…Adenocarcinoma
The most common site of origin of prostate cancer is in the peripheral zone (the main glandular zone of the prostate). The term adenocarcinoma can be split up to derive its meaning. Adeno means ‘pertaining to a gland’, whilst Carcinoma relates to a cancer that develops in epithelial cells. The term epithelial simply relates to cells that surround body organs or glands. Other carcinomas exits as the basal cell carcinoma

Small cell carcinoma
This kind of cancer is made up of small round cells, and typically forms at nerve cells. Small cell carcinoma is very aggressive in nature and as it does not lead to an increase in prostate specific antigens it can be somewhat harder to detect than adenocarcinoma; this usually means that it has reached an advanced form upon detection.

Squamous cell carcinoma
This is a non-glandular cancer, like small cell carcinoma there is no increase in prostate specific antigens when this is present. Squamous cell carcinoma is very aggressive in nature.

There are other, more rare, forms of prostate cancer these include sarcomas and transitional cell carcinoma; the latter rarely develops in the prostate but derives from primary tumors present in the bladder or urethra…”

Tests to prostate cancer prevention, therefore, should include not only the PSA but other reference markers that can alert to cancer regulated by other type of markers. Such as; the % free PSA, PAP, human aspartyl (asparaginyl) beta-hydroxylase (HAAH), EGFR, cancer sensitivity to chemo agents as well as bone scans, Ultra Sound, MRI and PET scans.
Carcinomas may need a personalized treatment for its type. Specialized clinics and institutions would care for this kind of tumor in regards to its sensitivity and resistance to drugs.

These are rare cases of prostate cancer but they exits.