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Therapy-associated effects in the prostate gland.

John R Srigley1, Brett Delahunt, Andrew J Evans

  • 1Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. jsrigley@cvh.on.ca

Histopathology
|January 4, 2012
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Pathologists must recognize how various prostate cancer therapies, including surgery and radiation, alter prostate tissue. These changes can complicate cancer diagnosis, staging, and Gleason scoring.

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Area of Science:

  • Uropathology
  • Oncologic Pathology
  • Surgical Pathology

Background:

  • Benign prostatic hyperplasia and prostate adenocarcinoma are treated with diverse therapeutic modalities.
  • Therapies such as transurethral resection, radiation, hormone therapy, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, and interstitial laser thermotherapy are employed.
  • These treatments induce morphological changes in prostate tissue, affecting both benign and malignant components.

Purpose of the Study:

  • To highlight the spectrum of histological changes in prostate tissue following various therapies.
  • To emphasize the importance of pathologist awareness regarding treatment-induced alterations.
  • To discuss the implications of these changes for accurate cancer diagnosis, staging, and prognostication.

Main Methods:

  • Review of histological findings in prostate biopsy and surgical specimens from patients treated with diverse therapies.
  • Analysis of morphological effects on non-neoplastic, pre-neoplastic, and carcinomatous prostate tissues.
  • Correlation of histological changes with specific treatment modalities.

Main Results:

  • Transurethral resection can cause necrobiotic granulomas.
  • Radiation and hormone therapy induce characteristic histological changes in neoplastic and non-neoplastic prostate glands.
  • Focal therapies and ablative procedures also result in distinct morphological alterations.
  • Treatment effects can obscure residual cancer, impede accurate staging, and invalidate Gleason scoring.

Conclusions:

  • Pathologists must be vigilant for treatment-induced histological changes in prostate specimens.
  • Awareness of these alterations is crucial for accurate interpretation of pathology samples post-therapy.
  • Understanding treatment effects is vital for reliable cancer assessment and prognostication, especially with evolving therapeutic landscapes.