Say no to FNAC in prostate cancer

Over 95 percent of malignancies arising in the prostate are adenocarcinoma. The remaining types include urothelial carcinoma, basal cell carcinoma, small cell carcinoma, lymphoma and sarcomas.

Core needle biopsy of the prostate is used to determine whether or not cancer is present in men with an elevated serum PSA level and/or an abnormal digital rectal examination.

The recommendation is to take multiple core biopsies under transrectal ultrasound guidance.

Primary diagnosis of prostate cancer by using fine needle aspiration is not acceptable.

When positive, the combined Gleason score, based upon architectural features of the prostate cancer cells, should be reported because it correlates closely with clinical behavior and has been incorporated into the tumor node metastasis (TNM) prognostic group staging system.

One should also report number of positive cores, the percentage (or length) of cancer in the positive core, the presence of perineural invasion or extraprostatic extension, and the presence of histologic types other than conventional adenocarcinoma.

The accuracy of pathological diagnosis of prostate cancer can be improved by using immunohistochemistry markers.