UROLOGICAL SURVEY   ( Download pdf )

 

PATHOLOGY

Different types of atrophy in the prostate with and without adenocarcinoma
Tomas D, Kruslin B, Rogatsch H, Schäfer G, Belicza M, Mikuz G
Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia
Eur Urol. 2007; 51: 98-103; discussion 103-4

  • Objectives: The purpose of this study was to evaluate, according to a classification proposed by a working group, the extent and type of atrophy lesions in radical prostatectomy specimens obtained from patients with prostatic carcinoma and benign prostatic hyperplasia (BPH), and to compare the prevalence and types of atrophy between two investigated groups.
  • Methods: Histologic analysis of 1096 slides from 50 patients with carcinoma and 277 slides from 31 patients with BPH was performed to evaluate, according to the new prostatic atrophy classification, the number of foci and type of atrophic lesions.
  • Results: Age, Gleason grade, and TNM showed no significant correlation with the number of proliferative atrophy (PA) and proliferative inflammatory atrophy (PIA) foci (p > 0.05). PIA was significantly more frequent in prostates with carcinoma (1.63 vs 1.27 atrophic lesions per slide) (p < 0.001), whereas PA displayed an increased frequency in BPH (2.28 vs 0.76 atrophic lesions per slide) (p < 0.001).
  • Conclusions: We confirmed that PA and PIA are common findings in prostates with and without carcinoma, but the question of whether inflammation produces tissue damage and PA or whether some other insult induces the tissue damage and atrophy directly, with inflammation occurring secondarily, is still unresolved.

  • Editorial Comment
    In this study, the authors found that patients with benign prostatic hyperplasia (BPH) had a significantly higher number of prostatic atrophy foci compared with patients with carcinoma. On the other hand, in patients with carcinoma, inflammatory prostatic atrophy was more prevalent compared with prostatic atrophy without inflammation, and slides from these patients contained a significantly higher number of inflammatory prostatic atrophy foci compared with slides from BPH patients. The authors recognize that slides with carcinoma contained peripheral and transitional zones, whereas slides with BPH were mainly composed of transitional zones. Thus, the obtained different prevalence of atrophy in malignant and benign cases could partially reflect the difference in distribution between various anatomic compartments of the prostate.
    In a study on autopsies, we found inflammatory atrophy in 66% and atrophy without inflammation in 22% of analyzed cases (1). We did not find any association between the presence of inflammatory atrophy and the likelihood of cancer, and no topographic association between atrophy and prostate cancer foci as well as high-grade prostatic intraepithelial neoplasia (PIN).
    The link between atrophy and /or inflammatory atrophy and prostate cancer is theoretically attractive but controversial (1-8). It has been difficult to verify a clinical connection between the lesions. A recent report associating extension of prostatic atrophy to serum PSA elevation added a novel interest to this intriguing lesion (9,10).

References
1. Billis A, Magna LA: Inflammatory atrophy of the prostate. Prevalence and significance. Arch Pathol Lab Med. 2003; 127: 840-4.
2. Billis A: Prostatic atrophy: An autopsy study of a histologic mimic of adenocarcinoma. Mod Pathol. 1998; 11: 47-54.
3. De Marzo AM, Marchi VL, Epstein JI, Nelson WG: Proliferative inflammatory atrophy of the prostate. Implications for prostatic carcinogenesis. Am J Pathol. 1999; 155: 1985-92.
4. Anton RC, Kattan MW, Chakraborty S, Wheeler TM: Postatrophic hyperplasia of the prostate. Lack of association with prostate cancer. Am J Surg Pathol. 1999; 23: 932-6.
5. Bakshi NA, Pandya S, Schervish EW, Wojno KJ: Morphologic features and clinical significance of post-atrophic hyperplasia in biopsy specimens of prostate. Mod Pathol. 2002; 15: 154A.
6. Postma R, Schröder FH, van der Kwast TH: Atrophy in prostate needle biopsy cores and its relationship to prostate cancer incidence in screened men. Urology. 2005; 65: 745-9.
7. Billis A, Freitas LL, Magna LA, Ferreira U: Inflammatory atrophy on prostate needle biopsies: Is there topographic relationship to cancer? Int Braz J Urol. 2007; 33: 355-63.
8. Mikuz G, Algaba F, Beltran AL, Montironi R: Prostate carcinoma: Atrophy or not arophy that is the question. Eur Urol. 2007; 52: 1293-6.
9. 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.
10. Billis A: Inflammatory atrophy on prostate needle biopsies: Is there topographic relationship to cancer? (Letter to the Editor) Int Braz J Urol. 2007; 33: 566-8.

Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br