Diagnostic challenges for the distinction of high-grade prostatic adenocarcinoma and high-grade urothelial carcinoma of simultaneous occurrences - A literature review

Abstract

Abstract: Two of the most prevalent types of cancer in men are prostate adenocarcinoma and urothelial carcinoma. Both can appear separately in the prostate and bladder, simultaneously as separate tumors affecting either organ or sporadically as a collision tumor. Distinguishing these tumors by the pathologist can be challenging, especially when the high-grade, poorly differentiated forms infiltrate the surrounding organs. The correct approach by the pathologist is important due to the different treatment modalities for these two entities. This review of the literature gives a comprehensive overview, our succinct understanding of the significance of correctly differentiating between these two tumors, the challenges involved in doing so, and the best collection of crucial and useful immunohistochemical markers for better diagnostic performance.The scientific papers used in this review were retrieved from the PubMed and Google Scholar databases. All the studies in this review have recently been peer-reviewed and published in academic journals. The literature was sifted through to find the most relevant and up-to-date information for medical professionals, specifically pathologists. The review concluded that: 1) Prostatic and urothelial markers such as NKX3.1, p63, thrombomodulin, and GATA3 are very useful for distinguishing prostatic adenocarcinoma from urothelial carcinoma. 2) Prostate Specific Antigen (PSA) is a good (clinical) screening tool, but because of its inverse relationship with tumor grade (the higher the grade, the lower the sensitivity of PSA staining), it is not recommended for high-grade tumor differentiation. 3) HMWCK (34βe12) and p63 are said to be more effective than thrombomodulin and S100p in detecting urothelial cancer. 4) Thrombomodulin is only moderately sensitive to urothelial carcinoma. 5) Cytokeratins 7 and 20 can be positive in both urothelial carcinoma and prostatic adenocarcinoma, therefore their use is restricted. The optimal combination of these markers may improve the ability to distinguish these tumors.