Active surveillance as a therapeutic option for patients with low-risk prostate cancer according to the 2014 International Society of Urological Pathology grading system: a review.

Extended prostate-specific antigen screening and the tightly focused execution of biopsies have resulted in an increased rate of detection, and thereby increased interventional treatment, of prostate cancer (PCa). The potential overdiagnosis and overtreatment of PCa patients have repeatedly been criticized in national and international literature. Controlled monitoring of patients in the setting of active surveillance (AS) can prevent overtreatment and the needless impairment of quality of life.

Significance of Number and Localization of Positive Core Biopsies for the Identification of Prostate Cancer Eligible for Active Surveillance.

Objective: Prostate cancer (PCa) patients fulfilling the Epstein criteria for insignificant disease are eligible for the treatment option of active surveillance (AS). Using the combined histological and cytological grading (Gleason/Helpap score), we aimed to investigate the significance of biopsy localization and tumor involvement in core needle biopsies as discriminators for insignificant cancer.

Study Design: Primary prostate biopsies of 1,285 patients were analyzed by the combined histological and cytological grading with regard to biopsy localization and tumor involvement per core.

The Significance of Accurate Determination of Gleason Score for Therapeutic Options and Prognosis of Prostate Cancer.

The Gleason score (GS) to date remains one of the most reliable prognostic predictors in prostate cancer (PCa). However, the majority of studies supporting its prognostic relevance were performed prior to its modification by the International Society of Urological Pathology (ISUP) in 2005. Furthermore, the combination of Gleason grading and nuclear/nucleolar subgrading (Helpap score) has been shown to essentially improve grading concordance between biopsy and radical prostatectomy (RP) specimens.

The Value of Prognostic Grouping of Prostatic Carcinomas for Urologists and Pathologists.

Objectives: To improve the prognostic stratification for different therapeutic options of prostatic carcinomas (PCa) with low and intermediate grade by combining Gleason grading with cytological findings and prognostic grade grouping.

Methods: We analyzed PCa after radical prostatectomy using the combined grading of Gleason and Helpap, which allows an exact differentiation particularly of low and intermediate grade tumors. Additionally, we attached time-interval and percentage value of recurrences of prostate-specific antigen (PSA) as well as death on disease (DoD) to the prognostic grade grouping.

The heterogeneous Gleason 7 carcinoma of the prostate: analyses of low and high grade (risk) carcinomas with criteria of the International Society of Urological Pathology (ISUP).

Prostate carcinoma (PCa) with Gleason score (GS) 7 has to be examined differentially regarding its prognosis. Using the criteria of ISUP and supplementations, we attempted to analyze the heterogeneity of PCa with GS 7 of biopsy and corresponding specimens of radical prostatectomies (RP). PCa of 530 patients were graded according to Gleason under additional consideration of the state of the nucleoli.

Significance of Gleason grading of low-grade carcinoma of the prostate with therapeutic option of active surveillance.

Introduction: Active surveillance needs a precise grading diagnosis of a low-grade carcinoma of the prostate (Gleason score (GS) 6) within a small organ-confined tumor. However, how accurate is the gold standard of GS 6 in predicting a small pT2 carcinoma? To answer this question, we have analyzed grading systems in this study.

Methods: Prostatic carcinomas in biopsy and corresponding radical prostatectomy (RP) specimens of 960 patients were graded by the Gleason system in which glandular fusions and nucleolar stage (prominence and location) were considered.

Combined histoarchitectural and cytological biopsy grading improves grading accuracy in low-grade prostate cancer.

Objectives: Accurate tumor grading on prostate biopsy represents the mainstay for therapy planning. Biopsy undergrading is a persistent diagnostic dilemma with therapeutic relevance. We questioned whether Gleason grading combined with an established alternative grading system incorporating cytological parameters improves grading accuracy.

Modified Gleason grading. An updated review.

Unlabelled: At an ISUP (International Society of Urological Pathology) consensus conference in 2005 in San Antonio, Texas, the old Gleason grading system for prostatic carcinoma from 1966 underwent its first major revision. With this modified Grading system a shift of the most frequent Gleason scores from 6 to 7a (3+4) in biopsy specimens and an increased degree of agreement between specimens of biopsies and radical prostatectomies with carcinoma of the prostate could be demonstrated. After modified grading of GS 3+4=7a tumours 95% were stage pT2, while 79% of GS 4+3=7b tumours were stage pT3-4.

Correlation of modified Gleason grading of prostate carcinoma with age, serum prostate specific antigen and tumor extent in needle biopsy specimens.

Objective: To investigate the correlation of biopsy grade with age, serum prostate specific antigen (PSA) and biopsy tumor extent using the conventional and modified Gleason grading systems.

Study Design: A total of 828 consecutive needle biopsy specimens of prostate carcinoma were collected from the years 1995 and 2000 (graded with conventional Gleason grading) and 2006 and 2007 (graded with modified Gleason grading).

Results: Both conventional and modified Gleason grading correlated with age, serum PSA, percent positive biopsies and percent cancer length.

Correlation of modified Gleason grading with pT stage of prostatic carcinoma after radical prostatectomy.

Objective: To study the correlation between modified Gleason score (GS) and pT stage of radical prostatectomy (RP) specimens.

Study Design: Six hundred forty-nine consecutive RP specimens were graded according to the conventional and the modified Gleason grading systems.

Results: A total of 29% of the tumors were upgraded.

Low frequency of molecular changes and tumor recurrence in inverted papillomas of the urinary tract.

Aim: Inverted papilloma (IP) of the urinary tract can be difficult to distinguish from noninvasive urothelial carcinoma with prominent inverted growth pattern (invNIUC). Ancillary markers may help to resolve such cases and clarify the reported malignant potential of some IPs.

Methods: Eighty-nine urothelial lesions initially diagnosed as IP were reviewed by 4 experienced urologic pathologists and studied immunohistochemically (Ki67, p53, CK20, MSH2, MLH1, and MSH6).

The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens.

At an International Society of Urological Pathology consensus conference in 2005, the Gleason grading system for prostatic carcinoma underwent its first major revision. Gleason pattern 4 now includes most cribriform patterns and also fused and poorly formed glands. Our aims were to compare the grade distributions and assess the agreement between biopsy and radical prostatectomy specimens for the modified and conventional Gleason grading.

Impact of hormonal therapy on the detection of promoter hypermethylation of the detoxifying glutathione-S-transferase P1 gene (GSTP1) in prostate cancer.

Background: In spite of excellent cure rates for prostate cancer patients with favorable tumor characteristics, patients with unfavorable characteristics after radical prostatectomy are still at a significantly increased risk of tumor progression. Early adjuvant hormonal therapy (AHT) has been shown to be of prognostic benefit in these patients. Unfortunately initiation and duration of early AHT in the individual patient is based on statistic data.

The significance of the P504S expression pattern of high-grade prostatic intraepithelial neoplasia (HGPIN) with and without adenocarcinoma of the prostate in biopsy and radical prostatectomy specimens.

Diagnosis of prostatic adenocarcinoma is usually not difficult in biopsy specimens. Problems may occur in biopsy specimens, containing only a few suspicious lesions. Recently, P504S has been tested as a new marker for prostatic carcinoma.

Prognosis of stage pT0 after prolonged neoadjuvant endocrine therapy of prostate cancer: a matched-pair analysis.

Objectives: Stage pT0 following prolonged neoadjuvant endocrine therapy (PPNET) of prostate cancer is of great clinical interest, because this finding suggests maximum tumor damage. Therefore pT0 patients are expected to have an extremely favorable PSA progression rate. The purpose of this study was to assess whether the PSA progression rate of pT0 patients after PPNET is lower than that of non-pT0 patients after PPNET.

Methylation-specific PCR for DNA-based detection of occult tumor cells in lymph nodes of prostate cancer patients.

Objectives: To assess the feasibility of methylation-specific PCR (MSP) for the detection of promoter hypermethylation of the detoxifying glutathione-S-transferase P1 gene (GSTP1) to detect occult prostate cancer cells in lymph nodes (LNs).

Methods: Paraffin-embedded pelvic LNs from 20 patients with pT2pN0M0R0 prostate cancer who developed PSA relapse were assessed by MSP. In 18 of the patients, samples of the primary tumor were obtained for MSP.

Follow-up of nondetectable prostate carcinoma (pT0) after prolonged PSA-monitored neoadjuvant hormonal therapy followed by radical prostatectomy.

Objectives: To test the hypothesis that in patients with Stage pT0 after prolonged prostate-specific antigen (PSA)-monitored neoadjuvant endocrine therapy, biochemical relapse is extremely rare and derives from systemic tumor recurrence.

Methods: A total of 227 patients with Stage cT1-3 carcinoma underwent PSA-monitored prolonged neoadjuvant endocrine treatment followed by radical prostatectomy. In all pT0 patients, PSA follow-up data were obtained.

Molecular pathology of non-invasive urothelial carcinomas (part I).

An international consultation on the diagnosis of non-invasive urothelial neoplasms was held in Ancona, Italy in May 2001. Besides histology and problems of classification, one group of experts (Committee no. 3) discussed the molecular pathology and cytometry of non-invasive urothelial carcinomas.

Nonepithelial tumor-like lesions of the prostate: a never-ending diagnostic problem.

Nonepithelial tumor-like lesions of the prostate include benign prostatic hyperplasia-associated stromal nodules, postoperative spindle cell nodules, benign mesenchymal tumors and sarcomas. These lesions and neoplasms are rare but need to be exactly classified for adequate treatment. This review focuses on the differential diagnosis between the various benign and malignant entities and compares the new WHO classification with a recently published typing of prostatic stromal lesions of unknown malignant potential.

Morphology and therapeutic strategies for neuroendocrine tumors of the genitourinary tract.

Background: Although many articles have been published regarding neuroendocrine tumors (NET) and neuroendocrine carcinomas of both low- and high-grade malignancy (NEC) of the genitourinary tract, the histologic diagnosis and therapeutic strategies for treating these entities remains difficult. In the current study the author discusses the significant differences between NET and NEC of the urinary bladder and the prostate, including therapeutic consequences.

Methods: Four hundred eighty neoplasms of the urinary bladder and prostate with a small cell pattern were analyzed not only on slides stained with hematoxylin and eosin but also by means of immunohistochemical stains demonstrating a neuroendocrine origin.

Fundamentals on the pathology of prostatic carcinoma after brachytherapy.

Morphologic analyses of radical prostatectomy specimens after brachytherapy are rarities, as only few patients undergo radical prostatectomy due to prostate-specific antigen (PSA) progress after brachytherapy. In the literature, there are merely sporadic reports that do essentially correspond to findings after conventional radiotherapy with regressive changes in the tumor glands and, especially, in the surrounding stroma. From the presented cases, it can be concluded that the seed density must be very high in order to prevent tumor progression through undamaged parts of the carcinoma.

Neuroendocrine carcinomas of the prostate and urinary bladder: a diagnostic and therapeutic challenge.

This review addresses the various morphological, immunohistochemical and cell kinetic aspects of pure and mixed neuroendocrine carcinomas of the prostate and urinary bladder and of carcinomas with focal neuroendocrine differentiation. It is important that neuroendocrine tumours of the prostate and urinary bladder be clearly distinguished from their nonneuroendocrine counterparts because of differences in treatment and prognosis. In the case of high-grade neuroendocrine carcinomas, early diagnosis and initiation of appropriate chemotherapy may increase survival and potentially induce complete remission in individual cases.