article · PubMed
Prostate lesions represent a major source of illness and death among adult men, with standard tissue evaluations occasionally yielding inconclusive results marked as suspicious for cancer. An evaluation of 1,691 prostate core needle biopsies collected over a five-year period examined the effectiveness of immunohistochemistry in resolving these uncertain findings. Initial microscopic assessments identified 57.8 percent of cases as benign, 39 percent as malignant, and 3.4 percent as suspicious. The suspicious tissue samples were subsequently analysed using two specific markers, alpha-methylacyl-CoA racemase and high molecular weight cytokeratin. This testing established that 67.2 percent of the suspicious samples were malignant, showing marker positivity for racemase and negativity for cytokeratin. The remaining 32.8 percent showed the opposite marker profile and were confirmed as benign, demonstrating the capacity of targeted marker staining to clarify ambiguous prostate diagnoses.
Prostate cancer diagnosis can be complicated by ambiguous tissue samples that delay appropriate treatment. Showing that dual-marker immunohistochemistry successfully distinguishes malignant tissue from benign conditions gives pathologists a reliable method to clear up diagnostic uncertainty. This ensures that patients receive accurate, timely diagnoses rather than undergoing repeated biopsies or facing inappropriate medical interventions.
The findings support clinical diagnostic applications for pathology laboratories and tertiary hospitals managing prostate cancer screening. The testing method relies on existing, standard immunohistochemical markers and staining apparatus, meaning it represents an applied and established clinical protocol rather than an experimental tool. Broader uptake depends on healthcare centres acquiring and routinely stocking the necessary staining equipment and antibody reagents to resolve inconclusive biopsy results.
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Background: Prostate lesions constitute a major cause of morbidity and mortality in Nigerian adult males. Prostate cancer (Pca) is now being reported as the second most frequently diagnosed malignancy in adult males. On some occasions, histopathological results may be inconclusive with the tissue sample tagged 'suspicious' of prostate cancer. Immunohistochemistry using Alpha methyl acyl CoA racemase (AMACR) and High molecular weight cytokeratin (HMWCK) can be used to clarify such cases. The study aims to evaluate the role of immunohistochemistry in resolving diagnostic dilemmas following core needle prostate biopsy. Methodology: This was a retrospective study performed between January 2013 and December 2017. The Hematoxylin and Eosin (H&E) stained slides and their corresponding archived formalin-fixed paraffin tissue blocks of cases over the study period were retrieved and reviewed. The suspicious cases were subjected to immunohistochemistry using AMACR and HMWCK to determine their actual status. Results: A total of 1838 prostate biopsy cases were received over the five-year period. A mean age of 69±9 years was observed, while the most common Gleason score was 6 [International Society of Urological Pathology (ISUP) grade group 1]. Among the 1838 prostate biopsy cases retrieved, 147 cases were excluded because of incomplete data. Hence, 1691 core needle prostate biopsies were used for the study. The highest number of core needle prostate biopsy cases were benign (57.8%), followed by malignant lesions (39%), whereas 3.4% were suspicious. Among the cases with suspicious status, 67.2% were AMACR marker positive and HMWCK marker negative, while 32.8% were AMACR marker negative and HMWCK marker positive. Therefore, 67.2% of the suspicious cases were resolved to be malignant and 32.8% were resolved to be benign. Conclusion: Immunohistochemistry is very useful in resolving cases of suspicious prostate lesions. The required staining apparatus should be made readily available in our tertiary centers.
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