The utility of PSMA and PSA immunohistochemistry in the cytologic diagnosis of metastatic prostate carcinoma

Abstract

The diagnosis of metastatic prostate carcinoma frequently requires the use of immunohistochemical adjuncts. Immunohistochemistry for prostate-specific antigen (PSA) is commonly used for this purpose but can be of limited utility. Recently, prostate-specific membrane antigen (PSMA) has been shown to be a promising marker for the identification of metastatic prostate carcinoma in surgical specimens. The utility of this marker has yet to be reported for cytology specimens. We sought to compare the sensitivities of PSMA and PSA immunohistochemistry and investigate the specificity of PSMA by utilizing cell block preparations from cytologic cases of metastatic prostate carcinoma (n = 19) and carcinomas of nonprostatic origin (n = 33). The sensitivity of PSMA immunohistochemistry was higher (16/19; 84%) in detecting metastatic prostate carcinomas than that of PSA immunohistochemistry (11/19; 58%). Strong, diffuse staining for PSMA was seen in 13 (81%) of 16 PSMA-positive cases whereas strong, diffuse staining for PSA was observed in six (55%) of 11 PSA-positive cases. Positivity for either PSMA or PSA was seen in 17 of 19 cases of metastatic prostate carcinoma for a combined sensitivity of 89%. PSMA immunohistochemistry was completely negative in 32 of 33 cytology cases of nonprostatic carcinomas. Therefore, the specificity of this marker was 97% in this study. In conclusion, our results indicate that PSMA is a highly sensitive and specific immunomarker for the detection of metastatic prostate carcinoma in cytology specimens.

Heterogeneous PSMA expression on circulating tumor cells - a potential basis for stratification and monitoring of PSMA-directed therapies in prostate cancer

“…Bernacki et al described PSMA as a highly sensitive and specific biomarker for the detection of metastatic prostate cancer cells in cytological specimens [11]. However, the high frequency of PSMA-negative CTCs in patients with PSMA-positive primary tumors detected in our study might be responsible for a lack of response to PSMA-targeting therapies in subpopulations of metastatic tumor cells.…”

Concise Review: Prostate Cancer Stem Cells: Current Understanding

“…Interestingly, PSA has been shown to inhibit OPG expression and increase mRNA expression of the ©AlphaMed Press 2018 STEM CELLS receptor activator of nuclear factor kappa-Β ligand (RANKL) that induces osteoclast differentiation [144]. It is worth mentioning that, in contrast to primary tumors that are almost always PSA positive, up to 40% of prostate metastases are negative for PSA expression [145,146].…”

Prostate cancer metastasis to the distal phalanx of the left hallux: The first confirmed case and literature review

“…PSA evaluation by immunohistochemistry has been demonstrated to be a useful tool for determining the diagnosis and prognosis of prostate cancer (21). However, PSA immunohistochemistry for the detection of metastatic prostate cancer can also be of limited utility (22). In the present case, the immunoreactivity of PSA staining tended to be mildly positive in the metastatic site.…”