[Prostatic adenocarcinoma--still a diagnostic problem]

Although the diagnosis of usual prostatic adenocarcinoma is not difficult by itself, problems may occur with diagnosis of small carcinomas in punch biopsies. Often small groups of suspicious glands are found with indistinct basal cell layer and lack of immunohistochemical expression of cytokeratin clone 34betaE12 or p63. Despite disturbed architecture, carcinoma cannot be diagnosed without cytological criteria of malignancy, especially prominent nucleoli. This is not only a frequent problem in routine diagnostic slides but also in consultation cases. The consequence of the diagnosis "suspicious" is repeat biopsy after an interval of 6-12 months. Recently, a new marker for prostatic carcinoma an alpha methyl CoA-racemase (P504S) has been tested. P504S is overexpressed in carcinoma-cells of the prostate. Together with negative basal cell marker P63 and positive reaction of P 504S this imunohistochemical combination confirms the diagnosis in 35-45% of so called suspicious prostate biopsies. Facit: this group of patients have now a distinct diagnosis and must have a definite treatment without repeat biopsy.