Definition/General

Introduction:
-Prostate adenocarcinoma is the most common malignancy in elderly men
-It accounts for 95% of all prostate cancers
-Most tumors are acinar adenocarcinomas
-Gleason grading system is used for prognostic assessment.
Origin:
-Arises from peripheral zone (70% cases)
-Transition zone (20% cases)
-Central zone (5-10% cases)
-Develops from prostatic intraepithelial neoplasia (PIN)
-Multifocal origin common.
Classification:
-WHO classification of prostate tumors
-Acinar adenocarcinoma (usual type)
-Ductal adenocarcinoma
-Special variants
-Gleason grading (Grade Groups 1-5)
-TNM staging.
Epidemiology:
-Most common cancer in men >50 years
-Peak incidence 65-75 years
-Higher in African Americans
-Family history increases risk
-Western diet and obesity as risk factors.

Clinical Features

Presentation:
-Often asymptomatic (early stages)
-Elevated PSA on screening
-Abnormal DRE
-Lower urinary tract symptoms
-Bone pain (metastatic disease)
-Hematuria (rare).
Symptoms:
-Urinary frequency
-Urgency
-Nocturia
-Weak stream
-Incomplete emptying
-Pelvic discomfort
-Erectile dysfunction
-Back pain (bone metastases).

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Gross Description

Microscopic Description

Immunohistochemistry

Molecular/Genetic

Differential Diagnosis

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Specimen Information

[specimen type], [approach], [weight] grams

Tumor Extent

Tumor involves [percentage]% of prostate, [multifocal/unifocal]

Gleason Score

Gleason score [X]+[Y]=[total], Grade Group [1-5]

Histologic Pattern

Predominant pattern: [Gleason pattern], Architecture: [description]

Extraprostatic Extension

Extraprostatic extension: [present/absent]

Seminal Vesicles

Seminal vesicle invasion: [present/absent]

Surgical Margins

Surgical margins: [negative/positive], location: [specify if positive]

Perineural Invasion

Perineural invasion: [present/absent]

Lymphovascular Invasion

Lymphovascular invasion: [present/absent]

Pathologic Stage

pT[stage] (AJCC 8th edition)

Prognostic Factors

Risk stratification: [low/intermediate/high] risk

Final Diagnosis

Final diagnosis: Prostatic adenocarcinoma, Gleason [X]+[Y]=[total], Grade Group [X], pT[stage]