Prostate pointers and pitfalls: the 10 most prevalent problems in prostate biopsy interpretation

As small volumes of prostate cancer are being detected with ever-increasing frequency, the pathologist is challenged to make more diagnostically out of less. This photoessay explores ten diagnostic problems that are noted with regularity by a provider of second opinions in prostate biopsy interpretation. These include: suboptimal submission of prostate cores, atypia with small size of the focus of concern, cytologic ambiguity of the focus of concern, issues with ordering and interpreting immunostains, atypia arising with high-grade prostatic intraepithelial neoplasia, benign mimics of cancer, omitting mention of extraprostatic tumor extension or of Gleason pattern 5, not recognizing intraductal carcinoma, and the differential diagnosis of cancer of urothelial versus prostatic origin.