Utility of racemase and other immunomarkers in the detection of adenocarcinoma in prostatic tissue damaged by high intensity focused ultrasound therapy.
OBJECTIVE
High intensity focused ultrasound (HIFU) is an emerging alternative for the treatment of prostate adenocarcinoma. Alpha-methylacyl-CoA racemase (AMACR) has been shown to be a sensitive immunomarker for prostate cancer, however, there is no information available concerning its utility and that of other immunomarkers for the detection of malignancy after HIFU therapy.


METHODS
AMACR expression was examined in 11 cases of prostatic carcinoma treated by HIFU, with histological evidence of residual carcinoma. In seven cases tumour was examined from thin core biopsies and in four cases from tissue fragments obtained by transurethral resection of prostate (TURP). In addition to AMACR, immunostaining was also undertaken for p63, cytokeratin 34betaE12, cytokeratin 5, cytokeratin 8-18, prostate specific alkaline phosphatase (PSAP), prostate specific antigen (PSA), chromogranin and CD56.


RESULTS
In two of the cases foci of tumour were cut out in serial sections. AMACR was expressed in eight of nine evaluable cases (4/5 biopsies and 4/4 TURP specimens). Cytokeratin 8-18 and PSAP were positive in all cases, whereas PSA was positive in five of nine cases. Cytokeratin 34betaE12, cytokeratin 5, and p63 marked the basal layer in normal prostatic glands, but were negative in neoplastic glands. In four cases we found tumour cells with positive staining for CD56 and chromogranin.


CONCLUSIONS
A panel with positive markers for AMACR, and negative markers for p63/cytokeratin 5/cytokeratin 34betaE12 confirms the neoplastic nature of the residual glands on biopsies or TURP fragments sampled after HIFU therapy.
Dalfior
Daniela
D
Department of Pathology, Università di Verona, Italy.
Delahunt
Brett
B
Brunelli
Matteo
M
Parisi
Alice
A
Ficarra
Vincenzo
V
Novara
Giacomo
G
Novella
Giovanni
G
Gobbo
Stefano
S
Valotto
Claudio
C
Chilosi
Marco
M
Menestrina
Fabio
F
Martignoni
Guido
G
D055011:Ablation Techniques / Q000379:methods; D000230:Adenocarcinoma / Q000201:enzymology* / Q000473:pathology / Q000628:therapy*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D003131:Combined Modality Therapy; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007124:Immunoenzyme Techniques; D053555:Keratin-5 / Q000378:metabolism; D007633:Keratins / Q000378:metabolism; D008297:Male; D009336:Necrosis / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000628:therapy*; D019998:Racemases and Epimerases / Q000378:metabolism*; D020728:Transurethral Resection of Prostate; D014464:Ultrasonic Therapy / Q000379:methods*; D014463:Ultrasonography
D014408:Biomarkers, Tumor; C121278:CK-34 beta E12; D053555:Keratin-5; D007633:Keratins; D019998:Racemases and Epimerases; C108352:alpha-methylacyl-CoA racemase