Diagnostic Usefulness of Monoclonal Antibody P504S in the Workup of Atypical Prostatic Glandular Proliferations

Lakshmi P. Kunju, Mark A. Rubin, Arul M. Chinnaiyan, Rajal B. Shah

Research output: Contribution to journalArticle

53 Scopus citations

Abstract

We stained 37 prostate needle biopsies and 3 transurethral resections (TURP) containing atypical foci and 20 morphologically unequivocal prostate cancer biopsies, including 4 with foamy features, with P504S. Of 20 biopsies with unequivocal cancer, 18 showed variable P504S staining (sensitivity, 90%); 1 minute cancer and 1 foamy cancer lacked P504S staining. Of 40 cases with atypical foci (biopsies, 37; TURP, 3), 9 were diagnosed as high-grade prostatic intraepithelial neoplasia (HGPIN), 2 were excluded, and 29 had foci of atypical small glandular proliferation. Of these 29 cases, 7 were highly suggestive of cancer, 2 of which lacked P504S staining. In 22 cases with benign atypical foci, 11 were diagnosed as postatrophic hyperplasia (none expressed P504S) and 7 as atypical adenomatous hyperplasia (AAH; 1 showed focal weak P504S staining). Of 9 HGPIN specimens, 8 showed predominantly diffuse, moderate P504S staining. P504S has slightly lower sensitivity for detection of prostate cancer than found previously. Heterogeneous expression patterns may explain negativity in some biopsy specimens with minute cancer. In atypical small glandular proliferations, diffuse positive P504S staining in atypical glands strongly supports a cancer diagnosis, but negative staining does not exclude it. P504S seems to have low sensitivity for detecting foamy prostate cancer. Most HGPINs show diffuse moderate P504S staining. AAH may show focal P504S staining. We recommend using P504S along with morphologic examination and conventional basal cell markers.

Original languageEnglish (US)
Pages (from-to)737-745
Number of pages9
JournalAmerican journal of clinical pathology
Volume120
Issue number5
DOIs
StatePublished - Nov 2003
Externally publishedYes

Keywords

  • AMACR
  • P504S
  • Prostate cancer
  • Prostate needle biopsies
  • α-Methylacyl-CoA racemase

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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