Detecting metastatic prostate carcinoma in pelvic lymph nodes following neoadjuvant hormone therapy: the eyes have it!

TitleDetecting metastatic prostate carcinoma in pelvic lymph nodes following neoadjuvant hormone therapy: the eyes have it!
Publication TypeJournal Article
Year of Publication2016
AuthorsKehr E, Masry P, Lis R, Loda M, Taplin M-E, Hirsch MS
JournalHistopathology
Volume68
Issue2
Pagination303-7
Date Published2016 Jan
ISSN1365-2559
KeywordsAbiraterone Acetate, Aged, Antineoplastic Agents, Biomarkers, Tumor, Carcinoma, Follow-Up Studies, Humans, Immunohistochemistry, Leuprolide, Lymph Nodes, Lymphatic Metastasis, Male, Middle Aged, Neoadjuvant Therapy, Pelvis, Prostate, Prostatectomy, Prostatic Neoplasms, Retrospective Studies
Abstract

AIMS: Residual cancer morphology in radical prostatectomies (RPs) after neoadjuvant hormone therapy includes inconspicuous cytology, and treated tumour cells can be difficult to identify in lymph nodes. The aim of this study was to evaluate the role of immunohistochemistry (IHC) in identifying occult lymph node metastases following neoadjuvant hormone treatment of prostate cancer.

METHODS AND RESULTS: One hundred and twenty-eight lymph nodes from 24 patients treated with neoadjuvant hormone therapy, including abiraterone acetate alone or combined with leuprolide, were stained with antibodies against keratin AE1/AE3, prostate-specific antigen (PSA), prostate-specific acid phosphatase (PrAP), androgen receptor (AR), and NKX3.1. IHC slides were scored 'blind', and then retrospectively compared with haematoxylin and eosin (H&E)-stained slides and pathology reports. IHC identified carcinoma in six lymph nodes from three patients. All metastases were positive for NKX3.1 and AR, five of six were positive for AE1/AE3, and three of six were positive for PSA; PrAP was negative in all metastatic foci. All six lymph node metastases had been identified by H&E staining at the time of RP.

CONCLUSIONS: These findings suggest that routine use of IHC on lymph nodes from neoadjuvant-treated prostate carcinomas is not necessary. Nevertheless, for suspicious small foci of atypical cells in neoadjuvant-treated lymph nodes, NKX3.1 and AR appear to have the greatest sensitivity.

DOI10.1111/his.12739
Alternate JournalHistopathology
PubMed ID26018610
Related Faculty: 
Massimo Loda, M.D.

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