Prostate cancer pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

On microscopic histopathological analysis, increased gland density, small circular glands, basal cells lacking, and cytological abnormalities are characteristic findings of prostate cancer.

Pathophysiology

Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone.

Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN).

Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor.

Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system.

Prostate cancer is considered a malignant tumor because it is a mass of cells which can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder.

When normal cells are damaged beyond repair, they are eliminated by apoptosis. Cancer cells avoid apoptosis and continue to multiply in an unregulated manner.

Gross Pathology

Prostate cancer is uncommonly apparent on gross.

Microscopic Pathology

Major criteria:

1.Architecture

• Increased gland density
• Small circular glands

• In rare subtypes - large branching glands

• "Infiltrative growth" pattern - malignant glands between benign ones

2.Basal cells lacking

3.Cytological abnormalities:

• Nuclear enlargement (subtle)
• Nucleoli (prominent)

Minor criteria:

• Nuclear hyperchromasia
• Wispy blue mucin
• Pink amorphous secretions
• Intraluminal crystalloid
• Amphophilic cytoplasm
• Adjacent High-grade prostatic intraepithelial neoplasia (HGPIN)
• Mitoses - quite rare

Prostate adenocarcinoma: Microscopic View

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Prostate Cancer and Endothelin

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