Histopathologic Features of Atypical Glands on Prostate Biopsy: Nucleolar Size Is A Predictor of Subsequent Detection of Prostatic Adenocarcinoma

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Patients whose prostate biopsy reveals the presence of atypical glands suspicious for carcinoma (AGSC) are subject to close monitoring and repeat biopsies, perhaps unnecessarily, as clinicians do not have a clear basis for understanding and stratifying the significance of these findings.


In a retrospective, blinded manner, we histopathologically examined initial biopsies reported as AGSC (82 patients, 93 foci). On subsequent biopsies, 31 (38%)/5 (6%) patients were found to have prostate cancer (PCA)/AGSC, respectively, while no carcinoma (NOCA) was identified in the remainder (56%) of cases.


Nucleolar grade (on a scale of 1–4 with “1” denoting small, inconspicuous nucleoli and “4” denoting macronucleoli) was significantly higher in PCA cases than in NOCA cases whether comparing all AGSC foci (P = 0.006) or when considering the highest grade in each patient (P = 0.009). However, the number of AGSC per focus was similar (P = 0.926) between PCA (mean ± SD: 7.03 ± 5.35) and NOCA (mean ± SD: 7.13 ± 4.44). Adjacent (P = 0.117) and separate (P = 0.457) high-grade prostatic intraepithelial neoplasia was found in 8/37 (22%) foci and 12/31 (39%) cases in PCA, respectively, and in 4/48 (8%) foci and 13/46 (28%) cases in NOCA, respectively. The presence of intraluminal dense secretion, crystalloid, or mucin in AGSC did not show a statistically significant correlation between PCA [5/37 (14%)] and NOCA [10/48 (21%)] (P = 0.567).


Our study may thus clarify the significance of AGSC on prostate biopsy and suggests that the size of nucleoli in AGSC is a positive predictor of subsequent detection of prostatic adenocarcinoma. Prostate 73: 376–381, 2013. © 2012 Wiley Periodicals, Inc.

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