Therapy‐associated effects in the prostate gland

Abstract

Diverse therapies are used to treat both benign prostatic hyperplasia and adenocarcinoma. Transurethral resection, a common surgical procedure, may give rise to characteristic necrobiotic granulomas that manifest in subsequent pathology samples. Radiation and hormone therapy have traditionally been used in prostatic adenocarcinoma. Morphological effects are often identified in needle biopsy specimens, transurethral resectates, and radical prostatectomy specimens. A range of histological changes are noted in the non-neoplastic prostate tissue, as well as in the pre-neoplastic and carcinomatous areas. Other ablative therapies, such as cryotherapy, and emerging focal therapies, including high-intensity focused ultrasound, photodynamic therapy, and interstitial laser thermotherapy, may have morphological effects on prostate tissue. It is important for the pathologist to be aware of the spectrum of histological changes affecting the prostate gland post-therapy. The treatment effects may obscure residual carcinoma, and make measurements of tumour extent and stage difficult. Furthermore, some therapies can profoundly alter the neoplastic glands to such an extent that Gleason scoring is no longer valid. As new therapies are developed for prostate cancer, it is important to document their effects on benign and malignant prostate tissue and to understand possible implications for traditional prognostic factors, especially Gleason grade.

Prostate Changes Related to Therapy: With Special Reference to Hormone Therapy

“…No significant histological changes in normal prostate tissue or PCa have been reported so far and their use will probably have no impact on the ability of pathologists to diagnose and grade PCa [1, 2,8]. The same applies to herbal supplements that promote prostate health, such as saw palmetto berry extract.…”

“…Vitamins D and E, as well as nutritional supplements such as selenium, green tea, tomato products and soy, used as potential preventative agents for PCa, are under investigation [1,2]. No significant histological changes in normal prostate tissue or PCa have been reported so far and their use will probably have no impact on the ability of pathologists to diagnose and grade PCa [1, 2,8].…”

“…Factors that have contributed to this rise include the aging of the population, coupled with growing awareness of the importance of early detection by measurement of serum prostate-specific antigen (PSA) levels and digital rectal examination. Many of these prostate cancers, whose most likely precursor is prostatic intraepithelial neoplasia (PIN) [2], are curable. In the hope of improving long-term disease-free survival, urologists are now increasingly performing radical prostatectomy (RP) in men with PCa that is localized upon presentation and with a life expectancy of more than 10 years [3].…”

“…Radiation and hormone therapy have also been used in PCa [1,2]. Other ablative therapies, such as cryotherapy and emerging focal therapies, including high-intensity focused ultrasound, photodynamic therapy and interstitial laser thermotherapy, may have morphological effects on prostate tissue (Box 1) [1,2].…”

“…In the hope of improving long-term disease-free survival, urologists are now increasingly performing radical prostatectomy (RP) in men with PCa that is localized upon presentation and with a life expectancy of more than 10 years [3]. Radiation and hormone therapy have also been used in PCa [1,2]. Other ablative therapies, such as cryotherapy and emerging focal therapies, including high-intensity focused ultrasound, photodynamic therapy and interstitial laser thermotherapy, may have morphological effects on prostate tissue (Box 1) [1,2].…”