prostate cancer wrong diagnosis? suspicious for but not diagnostic of…what?

I’ve told patients for years that the diagnosis of prostate cancer is an easy one to make for the pathologist. It is probably the most common biopsy they get on a day to day basis. I refer to it as a “bread and butter” diagnosis. The inference is that it is not a uncommon diagnosis and it is something all pathologists see often. I have been asked to send off the slides of a prostate biopsy that was read out as positive on many occasions. I have never had one over turned or the diagnosis changed. In addition to prostate cancer being something that the community pathologist sees often, there are now stains available to confirm the diagnosis in difficult cases.

Prostate cancer is an infiltrative cancer, so the pathologist makes the diagnosis more on the pattern of the prostate cancer glands than on the specific nature of the cells. The pathologist where I trained in Augusta, Georgia had a particular interest in prostate cancer. He would describe the prostate cancer as tiny circles emanating from areas of normal prostate glands. He would make little circles with his fingers and then move them all about the screen projecting the microscopic finding  of  prostate cancer.

PIN or Prostatic intra-nuclear neoplasm is when the cell of the prostate is abnormal but the cells are in the normal pattern. These patients are at increased risk for developing prostate cancer and are usually followed more closely than the average patient.

Suspicious for but not diagnostic of prostate cancer type glands are in a pattern that mimic prostate cancer. This where the stains come in and are utilized to confirm the diagnosis. I suppose in the case of this article, this was not done. Now here’s the thing. The author of this article  is still at increased risk of developing prostate cancer and should be closely monitored and even re-biopsied. Remember this about a prostate biopsy, it usually is twelve cores and that only samples a small percentage of the gland. So if your prostate biopsy shows “suspicious” and your repeat  biopsy is completely negative,  you still have the suspicious cells. This happens as a result of “low volume” disease. This can get confusing.  For this patient the change is diagnosis is a good thing, but he is not off the  hook for future  issues. He’ll need biopsies in the future. For the most part, we know that does not have large volume ,  high Gleason’s prostate cancer, and that’s a good thing.