Humpath.com - Human pathology

Home > E. Pathology by systems > Reproductive system > Male genital system > Prostate > post-radiation prostate acinar adenocarcinoma

post-radiation prostate acinar adenocarcinoma

Sunday 12 February 2012

Radiation therapy can be given as either external beam or interstitial seed implants or as a combination of the two.

After radiation therapy the prostate gland is usually small and hard.

Radiation therapy affects prostate cancer variably with some glands showing marked radiation effect and others showing no evidence of radiation damage.

Architecturally, carcinoma showing treatment effect typically loses their glandular pattern, resulting in clustered cells or individual cells.

Cytologically, the cytoplasm of the tumour cells is pale, increased in volume and often vacuolated. There is often a greater variation of nuclear size than in non-irradiated prostate cancer and the nuclei may be pyknotic or large with clumped chromatin. Nucleoli are often
lost.

Paradoxically the nuclear atypia in prostate carcinoma showing radiation effect is less than that seen in radiation atypia of benign glands.

By immunohistochemistry, tumour cells with treatment effect are usually positive for PAP and PSA.

These antibodies along with pancytokeratins are very helpful to detect
isolated residual tumour cells, which can be overlooked in H&E stained sections.

The stroma is often sclerosed, particularly following radioactive seed implantation.

In the latter the stromal hyalinization is often sharply delineated. Following radiation therapy, prostatic biopsy should be diagnosed as no evidence of cancer, cancer showing no or minimal radiation effect, or cancer showing significant radiation effect, or a combination of the above.

Although there exists various systems to grade radiation effects, these are not recommended for routine clinical practice.

Biopsy findings predict prognosis with positive biopsies showing no treatment effect having a worse outcome than negative biopsies, and cancer with treatment effect having an intermediate prognosis.