17
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
17-22
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
The article highlights clinical and morphological characteristics of prostate cancer. The results of the carried out
researches at the character study, pathogenesis of the development and diagnostics testify to the increase of number
of so called "hormone-resistant" cases of the prostate cancer. It has been established that morphological diagnosis
of prostate cancer is difficult, because signs of malignancy may be barely visible, which increases the probability of a
false-negative result. At the same time there are many benign processes that mimic a malignant tumour, which can
lead to misdiagnosis. In recent years, the use of immunohistological markers to detect basal layer cells has been
recommended. Their level can be determined by immunohistochemical examination, which is elevated in prostate
cancer.
KEYWORDS
Prostate cancer, clinic, morphology, diagnosis.
Research Article
CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF PROSTATE
CANCER
Submission Date:
February 10, 2022,
Accepted Date:
February 20, 2022,
Published Date:
February 28, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue02-05
Hamza Abdukodirovich Rakhmanov
Assistant of department of pathological anatomy Samarkand State Medical Institute, Uzbekistan
Shavkat Erjigitovich Islamov
Doctor of Medical Sciences, associate professor at the department of pathological anatomy Samarkand
State Medical Institute, Uzbekistan
Nodir Mukhammadievich Rahimov
Doctor of Medical Sciences, Assistant Professor, Department of Oncology Samarkand State Medical
Institute, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
18
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
17-22
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
INTRODUCTION
Prostate cancer remains the most frequent solid
tumour in American and European men. There are an
estimated 250,000 new cases of this disease in the
United States each year and approximately 30,000
men die from it .
With the widespread introduction of prostate specific
antigen detection, the frequency of diagnosis of
localized and locally advanced stages of prostate
cancer has increased considerably. In Europe and the
USA, non-palpable stages of prostate cancer account
for 75% of detected cases. The results of the Prostate,
Lung, Colorectal, and Ovarian Cancer Screening Trial
(PLCO) and the European Randomized Study of
Screening for Prostate Cancer are presented. Based on
the initial results of the studies, antigen-based
screening can reduce prostate cancer mortality by
approximately 20%, but leads to a risk of detecting
clinically insignificant masses. It has been noted that a
differentiated approach to newly diagnosed cases of
pathology is needed, assessing the individual risks of
the patient.
PURPOSE OF THE RESEARCH
To establish clinical and morphological characteristics
of prostate cancer.
MATERIAL AND METHODS OF THE RESEARCH
As objects we studied living patients with prostate
cancer who were hospitalized in Samarkand regional
branch of the Republican Specialized Scientific-
Practical Medical Center of Oncology and Radiology
(20), analyzed their medical documents (case records),
as well as the results of clinical and laboratory
investigations, data of morphological studies. We took
into account the results of follow-up, macroscopic,
microscopic (hematoxylin and eosin staining),
morphometric and statistical research methods.
RESULTS OF THE STUDY AND THEIR DISCUSSION
Clinical signs
: In most men with adenocarcinoma (T1a)
incidentally detected by transurethral resection of the
prostate, the process does not progress for 10 years or
more. In this case, only dynamic monitoring is
necessary for older patients, while younger men with a
longer life expectancy may require needle biopsy to
rule out a malignancy in the periphery of the prostate.
Tib tumors are more dangerous. They are treated in the
same way as tumors identified by needle biopsy,
because they are fatal in 20% of cases without
treatment.
Localized prostate cancer is asymptomatic and usually
appears as a nodule on rectal palpation or if the PSA
level in the serum {prostate specific antigen} is
elevated. Prostate cancer usually originates in the
periphery away from the urethra, and therefore urinary
disorders are only seen at a late stage.
Clinical manifestations of prostate cancer include
difficulty in beginning to urinate or interruption of the
flow of urine, dysuria, rapid urination, or hematuria. It
is now rare for patients to complain of low back pain
caused by metastases to the spine. Detection of
osteoblastic metastases on review radiographs or with
more sensitive radioisotope bone scans allows a
diagnosis of prostate cancer. These patients have an
unequivocally unfavorable prognosis.
The rectal finger examination can detect carcinoma at
an early stage if it is localized posteriorly (but this
method has low sensitivity and specificity). Transrectal
ultrasound (USG) and other imaging modalities reveal
characteristic signs of prostate cancer, but the low
19
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
17-22
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
sensitivity and specificity of these methods also limit
their use in practice. Transrectal needle biopsy of the
prostate gland is usually necessary to confirm the
diagnosis.
The PSA test is the most important test in the diagnosis
of prostate cancer and the evaluation of the efficacy of
treatment (6). PSA is formed in the epithelial cells of
the prostate gland and is normally secreted into the
seminal fluid. PSA is a serine protease whose main task
is to keep the semen fluid after ejaculation. Normally,
men have very low plasma PSA concentrations.
Elevated PSA levels can be caused by either localized or
advanced malignancy. Most laboratories consider a
PSA level of 4 ng/ml to be a borderline value. However,
this approach to PSA level determination is not
accurate, which may cause a delay in the diagnosis of
prostate cancer.
PSA is a specific marker for an organ, but not for
cancer. Factors such as prostatitis, heart attack,
instrumental prostate exams, and ejaculation can also
contribute to an elevated PSA. Moreover, 20-40% of
patients with localized prostate cancer have PSA
concentrations of 4 ng/ml or lower.
The PSA test is so detailed because it is ubiquitous, and
because it is difficult and prone to misinterpretation. In
fact, the PSA test is a test to detect malignancy.
Consequently, physicians should ensure that test
results are returned from the laboratory, that PSA
values that differ from normal are recorded, and that
patients are called in for consultation if their levels of
this antigen are elevated. Most medical errors are the
result of underestimating PSA levels and thus causing
a delayed diagnosis of malignancy.
Morphology
: In 70% of cases, carcinoma of the
prostate gland is localized in its peripheral zone
(usually in the posterior part of the gland, which allows
to palpate the tumor during rectal finger examination).
It is characteristic that on the section of the gland the
tumor tissue is granular and dense. If a tumor is located
in the prostate gland tissue, it is poorly visualized, but
easier to detect by palpation. Local spreading usually
involves the periprostatic tissue, the seminal vesicles,
and the base of the bladder, which in advanced forms
may lead to urethral obstruction. Metastases first
spread through the lymphatic vessels to the level of
the obstructing lymph nodes and reach the para-aortic
lymph nodes. Hematogenous dissemination occurs
mainly in bone, especially in the bones of the axial
skeleton, but in some cases there is massive
dissemination to internal organs (the exception rather
than the rule). Bone metastases are usually osteoblasts
and, if found in men, clearly indicate the presence of
prostate cancer. The most frequently affected area is
the lumbar spine, followed (in descending order of
frequency) by the proximal femur, pelvic bones,
thoracic spine, and ribs.
Histologically,
most
prostatic
tumors
are
adenocarcinomas, which are characterized by well-
defined, easily defined glandular structures. Tumor
glands are usually smaller in size and lined by a single
layer of cubic cells or by low cylindrical epithelial cells.
Tumor glands are located closer to each other and,
characteristically,
lack
branching
or
papillary
invaginations. Tumor glands lack external basal layer
typical for glands of normal organ. Cytoplasm of tumor
cells varies from dull-light, typical for cells of
unchanged glands, to distinctly amphophilic. The
nuclei are large and often contain one or more large
nuclei. There are some differences in the size of nuclei
and their shape, but on the whole, pleomorphism is not
very
pronounced.
Figures
of
mitosis
are
uncharacteristic.
20
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
17-22
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
The diagnosis of prostate cancer represents one of the
greatest challenges for the anatomical pathologist.
The problem is not only the insufficient amount of
tissue obtained during needle biopsy for histological
examination, but also the fact that often the biopsy
specimens contain only a few tumor glands among
many normal ones (Fig. 1). Morphological diagnosis of
prostate cancer is also difficult because signs of
malignancy can be subtle, which increases the chance
of a false negative result. There are also many benign
processes that mimic a malignant tumor, which can
also lead to misdiagnosis. Although there are several
histological features specific to prostate cancer, such
as perineural invasion, the diagnosis is made when a
combination of tissue, cellular, and some additional
features are present. As noted earlier, the main
distinguishing feature of a benign process in the
prostate is the presence of cells in the basal layer,
whereas their absence is indicative of prostate cancer
(Fig. 1) .
Pathologists
use
this
peculiarity
by
using
immunohistological markers to detect cells of the basal
layer. Immunohistochemical testing can be used to
determine the level of AMACR, which is elevated in
prostate cancer. The majority of malignant tumors of
the prostate give a positive reaction to AMACR. The
sensitivity of this method varies from 82 to 100%. The
use of these markers to increase the accuracy of
prostate cancer diagnosis has its limitations because of
the possibility of false-positive and false-negative
results; therefore, routine hematoxylin and eosin
staining should also be performed.
In = 80% of cases, high grade PIN is also found in
prostate tissue with carcinoma. PIN is characterized by
the presence of normal prostate glands lined by
atypical cells with pronounced nuclei. Cytologically,
PIN and carcinoma may be identical, but on the tissue
level, PIN is characterized by larger branching glands
with papillary overgrowths in contrast to invasive
cancer, in which small glands with smooth lumen
boundaries are closely spaced.
The glands of PIN are lined by a discontinuous basal
layer and an unchanged basal membrane. PIN and
invasive cancer have several features in common. First,
they localize predominantly in the peripheral zone. If
we compare the prostate gland affected and
unaffected by a malignant tumor, PIN is more often
found in the prostate gland with a tumor. PIN is usually
located in close proximity to the malignant tumor, and
in some cases is transformed into it. Most of the
molecular changes characteristic of invasive cancer are
also present in PIN, confirming the fact that PIN is a
transitional link between unaltered tissue and invasive
cancer. However, the cause of PIN and how often it
transforms into cancer is still unknown, so the term
"carcinoma in situ" is not applicable to PIN (unlike
cervical cancer).
21
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
I
SSUE
02
Pages:
17-22
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
А
В
Fig. 1. (A) Adenocarcinoma of the prostate characterized by small tumor glands arranged in groups between
larger normal glands. (B) Several small tumor glands characterized by enlarged nuclei, prominent nuclei, and dark
cytoplasm are seen under high magnification (top)
Repeated measurements of PSA levels are very
important in evaluating the effectiveness of therapy.
For example, elevated PSA levels after radical
prostatectomy or radiation therapy for localized
cancer indicate recurrence or dissemination of tumor
cells. Detection of PSA by immunohistochemical
examination in samples of prostate tissue can also help
a pathologist to establish the presence of a metastatic
tumor in the prostate [6].
Surgical method, radiation therapy, and hormonal
therapy are used for treatment of prostate cancer. Life
expectancy for more than 90% of patients receiving this
treatment is about 15 years. Currently, the most
common method of treatment for localized prostate
cancer is a radical prostatectomy. Its prognosis
depends on the stage of the disease, the condition of
the tissue at the border of the resection, and the
degree of Gleason malignancy. An alternative method
of treating localized prostate cancer is distant or
intradermal radiotherapy, which consists of placing
radioactive sources of radiation (brachytherapy) into
the prostate tissue. Radiation therapy is also used to
treat localized tumors that are too small to be treated
by surgery.
Hormone therapy in patients with N0 stage did not
improve the results of surgical treatment . Hormone
therapy in patients with locally advanced disease (T3)
did not reduce the risk of tumor cells at the incision
margin.
Because some prostate tumors are characterized by a
relatively asymptomatic course, it can take up to 10
years before the benefits of surgery or radiation
therapy can be evaluated. Because of this, active
surveillance may be recommended for most older men,
men with significant comorbidities, and even some
younger men with low PSA levels and locally highly
differentiated prostate cancer.
Prayer-Galetti T. et al. conducted a prospective
randomized study that included 201 patients with stage
C prostate cancer and revealed that adjuvant hormone
therapy with gonadotropin-releasing hormone agonist
goserelin (zoladex) in a dose of 3.6 mg subcutaneously
every 28 days after radical prostatectomy significantly
22
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
17-22
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
increases recurrence-free survival compared to
surgical treatment alone in high risk prostate cancer
patients.
Treatment of advanced metastatic carcinoma of the
prostate is based on the removal of androgen
exposure through orchiectomy or by taking synthetic
luteinizing hormone (LH) releasing factor agonists.
Prolonged use of these agonists leads to a state of drug
castration. However, although anti-androgen therapy
leads to remission, the tumor eventually becomes
resistant to testosterone, after which it rapidly
progresses to death.
CONCLUSIONS
The obtained results of the research testify to the fact
that the clinical and morphological criteria of the
prostate cancer are incompletely developed. Thus
there is an increase of so called "hormone resistant"
prostate cancer cases. At the same time morphological
diagnostics of prostate cancer is difficult because the
signs of malignancy can be hardly visible, which
increases the probability of false negative result. There
are also many benign processes that mimic a malignant
tumor, which can also lead to misdiagnosis. In recent
years, the use of immunohistologic markers to detect
basal layer cells has been recommended. With the help
of immunohistochemical study it is possible to
determine their level, which is increased in prostate
cancer.
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