MY APPROACH

My approach to intraductal lesions of the prostate gland

M Pickup and T H Van der Kwast

Department of Pathology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada

Correspondence to:
Correspondence to:
Professor T H van der Kwast
Department of Pathology, 11th Floor, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4; theo.vdkwast{at}uhn.on.ca

The morphologically heterogeneous (intra)ductal lesions of the prostate frequently present a diagnostic challenge, particularly when found within prostate needle biopsies. By current convention, all high-grade intra-acinar and intraductal neoplastic lesions of prostatic origin fall under the diagnostic umbrella term: prostatic intraepithelial neoplasm (PIN). Although a long-standing contentious issue, some lesions currently adhering to the diagnostic criteria of PIN may actually represent the intraductal spread of (generally high grade) invasive cancer. Illustrating this fact, the well-described ductal subtype of prostatic adenocarcinoma is frequently associated with conventional-type acinar adenocarcinoma, and has a tendency to propagate within adjacent intact prostatic ducts. Clearly, the misdiagnosis of lesions representing invasive disease as preinvasive has the potential for unfavourable clinical sequelae. As yet, however, many of these lesions have escaped the establishment of reliable morphologic criteria or immunohistochemical differentiation for diagnosis. By defining stringent architectural and cytonuclear features specific for each of these lesions, it may be feasible to separate potentially sinister lesions from the subset of traditional (preinvasive) PIN lesions with limited clinical urgency. This review discusses the (intra)ductal lesions of the prostate, along with their differential diagnoses. Given the current state of knowledge, a pragmatic approach to their effective reporting is outlined, taking into consideration the clinical implications, as well as current guidelines for treatment and follow-up.

Abbreviations: AMACR, -methylacyl coenzyme A racemase; PAP, prostatic acid phosphatase; PIN, prostatic intraepithelial neoplasm; PSA, prostate-specific antigen

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This article has been cited by other articles:

• Henry, P C, Evans, A J (2009). Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications. J. Clin. Pathol. 62: 579-583 [Abstract] [Full Text]