Expression and Diagnostic Utility of AMACR And 34β E 12 in Prostatic Lesions.

Across the world, Carcinoma of the Prostate is one of the most common malignancies, the accurate diagnosis of which is of major concern. In the list of malignancies excluding skin cancers, it comes second. Its incidence has steadily risen with time. This is attributed to the increased life span and also to the westernisation of lifestyle typified by diet with high calories and inadequate exercise to the body. Serum PSA is increasingly being used as a screening tool. Consequent to it, prostate needle biopsies are increasingly performed in men. Increased prostate-specific antigen levels increases needle biopsies, for the exclusion of prostate cancer. Prostatic needle biopsy is the preferred method. It has fewer side effects, and helps with accurate information regarding degree of tumor extension. The grade of tumor is also diagnosed with precision. But, a needle biopsy presents problems. Only a small tissue amount is provided for microscopic examination. It is a difficult task to accurately diagnose small foci of prostate cancer for pathologists and to distinguish cancer from its benign mimickers. Small malignant infiltrating glands graded as 6 on the Gleason score pose the volume of difficulty in prostatic specimens. AIM OF THE STUDY : To study the Expression and Diagnostic utility of Immunohistochemical markers AMACR and 34βE12 in various Prostatic lesions. OBJECTIVES OF THE STUDY : 1. To find out the incidence of various prostatic lesions in men 2. To study the clinical presentation of prostatic lesions 3. To study the sensitivity and specificity of AMACR and 34βE12 4. To study the expression of AMACR and 34βE12 in various prostatic lesions 5. To study the use of AMACR and 34βE12 in detecting limited samples of prostate . CONCLUSION : In the present study the incidence of prostatic carcinoma was common in the age group of 71-75 years. Incidence of prostatic carcinoma was 38%, prostatic intraepithelial neoplasia was 10%, benign prostatic hyperplasia was 48% AMACR grading: 74% cases showed Grade 3 positivity 10% cases showed Grade 2 positivity 5% cases showed Grade 1 positivity 10% cases showed Grade 0 positivity The sensitivity of AMACR in detection of prostate carcinoma was 90% and specificity was 100%. The sensitivity of 34βE12 detection of prostate carcinoma was 100% and specificity was 89%. Newer antibodies against prostatic tumor cells (p504s) and prostatic basal cells (34βE12,p63,CK 5/6) have proven to beneficious. The results showed that, for ambiguous lesions such as atypical small acinar proliferation, small foci of prostatic carcinoma not diagnosed, but suspected to be malignant can be benefited by the use of these markers. Immunohistostaining with 34βE12 and p504s has improved diagnostic uitility in microscopically difficult cases. It helps to avoid newer and subsequent prostatic biopsies ,which are costlier and causing morbidity in the patients. The application of these newer antibodies individually is less relavant than the combined use of these antibodies. Compared to a new series of biopsies, the cost of immunohistochemical techniques remains lower . So, the conclusion is that in conjuntion with the clinical scenario and morphology, a combination of prostatic epithelial marker AMACR and basal cell marker HMWCK is of better value in diagnosing the prostate carcinoma cases and other morphologically difficult lesions. Hence, the accuracy of diagnosis in prostate cancer is significantly increased. However, it should be kept in mind about the limitations of both the markers. In summary, from several institutions, various type of studies have demonstrated that AMACR/ P504S is an important positive epithelial cell marker for prostate cancer. A sensitivity ranging from 82% to 95% and a specificity ranging from 79% to 100% was achieved, regardless of tumor grade; as well as with different criteria for positive stains in benign and malignant glands Hence,AMACR has the potential to be a useful marker which can be used seperately for prostate carcinoma in clinical pathology practice. Similarly 34βE12 has a high specificity and sensitivity for identifying prostate lesions in biopsies