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This Article Full Text Full Text (PDF) All Versions of this Article: jcp.2006.043224v1 60/8/856    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pickup, M Articles by Van der Kwast, T H Search for Related Content PubMed PubMed Citation Articles by Pickup, M Articles by Van der Kwast, T H Pubmed/NCBI databases Medline Plus Health Information Prostate Cancer Topic Collections Editor's choice

My approach to intraductal lesions of the prostate gland

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

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
ABSTRACT
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.