Prostate
Prostatic carcinoma
Immunohistochemistry


Topic Completed: 1 April 2015

Revised: 15 May 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Immunohistochemistry [title] prostate

Kenneth A. Iczkowski, M.D.
Page views in 2018: 8,003
Page views in 2019 to date: 4,637
Cite this page: Iczkowski KA. Immunohistochemistry. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostateihc.html. Accessed July 17th, 2019.
Definition / general
Terminology
  • The two main types of immunostains for workup of minute foci of carcinoma or suspicious for carcinoma are a basal cell immunostain cocktail (consisting of cytoplasmic marker cytokeratin 34βE12, also called cytokeratin 903, plus nuclear marker p63), and alpha-methylacyl CoA racemase (AMACR, P504S)
  • These are often used together in a cocktail in a double stain or a triple stain
Uses by pathologists
  • The International Society of Urologic Pathology (ISUP) has issued these recommendations (Am J Surg Pathol 2014;38:e6) for deciding when to perform prostate basal cell immunostains or the combination triple stain cocktail including AMACR:
    • In the setting of obvious benign acini or obvious cancer, there is no justification to perform immunostains
    • In a multi-part biopsy with 4+3=7 or 4+4=8 cancer in 1 part and ASAP suspicious for the same grade cancer in other part(s), workup is justified, since the extent of high grade cancer affects treatment
    • In a multi-part biopsy with 3+3=6 cancer in 1 part and ASAP suspicious for 3+3=6 cancer in other part(s), workup is justified, because the number of biopsy sites positive for cancer and the % core involvement of those sites could affect therapeutic choices for active surveillance, focal therapy or surgery
    • In a multi-part biopsy with ≥ 3+4=7 cancer in 1 part and ASAP suspicious for 3+3=6 cancer in other part(s), workup is NOT justified, because stains are unlikely to change treatment
    • In a multi-part biopsy with ≥ 4+3=7 cancer in 1 part and "atypical cribriform lesion" (ACL) suspicious for intraductal carcinoma versus invasive, Gleason pattern 4 cancer in other part(s), workup is NOT justified, because intraductal carcinoma is almost always closely associated with invasive high-grade cancer - thus workup of additional cribriform lesions is not contributory
  • For the diagnosis of prostate cancer, the ISUP recommends PSA, with possible back-up use of PSAPP501S/prostein, and prostate specific membrane antigen (PSMA) (Am J Surg Pathol 2014;38:e6)
  • For the diagnosis of urothelial cancer, the ISUP recommends GATA3, a zinc finger transcription protein, with backup use of uroplakins, thrombomodulin or the more widely available cytoplasmic cytokeratin 34βE12 and nuclear p63
Back to top