Histologic Findings on Prostate Needle Core Biopsies Following Cryotherapy as Monotherapy for Prostatic Adenocarcinoma
Casey E Gooden, Charles K Kovach, Peter T Nieh, Adeboye O Osunkoya. Emory University School of Medicine, Atlanta
Background: The histologic features seen in the prostate following cryotherapy can be highly variable. However, most previous studies were performed on specimens following salvage cryotherapy which introduces additional confounding variables of the histologic changes after other treatment modalities. We examined prostate needle core biopsies from a cohort of patients following cryotherapy as monotherapy for prostatic adenocarcinoma (PCa), to evaluate the true spectrum of morphologic changes in the prostate.
Design: A search was made through the surgical pathology and expert consultation files of the senior author for prostate needle core biopsies following cryotherapy. Cases that had prior radiation therapy or androgen deprivation therapy were excluded from the study. The Gleason scores from the original needle core biopsies were documented. All histologic findings from the post-cryotherapy needle core biopsies including time interval from therapy to repeat biopsy were also documented.
Results: 30 cases were identified. Average patient age was 69 years (range: 51-81 years), and the average time interval between cryotherapy and repeat biopsy was 19.2 months (range: 2-60 months). The original Gleason scores were as follows: 3+3=6 in 14/30 cases (46%), 3+4=7 in 8/30 cases (27%), 4+3=7 in 2/30 cases (7%), 4+4=8 in 3/30 cases (10%), 4+5=9 in 2/30 cases (7%), and 5+4=9 in 1/30 cases (3%). Post cryotherapy, 11/30 cases had recurrent/residual PCa which showed no therapy related changes, similar to the residual benign glands. Gleason scores were higher in 5/11 cases (46%), same in 4/11 cases (36%) and lower in 2/11 cases (18%). Additional histologic findings were as follows: chronic inflammation 24/30 cases (80%), myxoid stromal change 24/30 cases (80%), hemosiderin pigment in the stroma 21/30 cases (70%), stromal fibrosis 9/30 cases (30%), necrosis 8/30 cases (27%), calcifications 6/30 cases (20%), acute inflammation 5/30 cases (17%), granulomas 4/30 cases (13%), hemorrhage 4/30 cases (13%), vessel wall thickening and prominent endothelial cells 3/30 cases (10%), squamous metaplasia 3/30 cases (10%).
Conclusions: This is one of the first studies to review the histologic findings following cryotherapy as monotherapy for PCa. Unlike other non-surgical therapeutic modalities, cases with recurrent/residual PCa and benign glands showed therapy related changes predominantly involving the stroma. It is therefore conceivable that benign or malignant prostatic glands are either completely destroyed during cryotherapy, or left unaltered if not in the direct field of cryoablation.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 128, Monday Morning