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J I Epstein

Publications and source records attributed to J I Epstein.

At least 163 records · Page 9Linked to original sources
PubMed1997

Prospective evaluation of men with stage T1C adenocarcinoma of the prostate.

PURPOSE: The pathological characteristics of stage T1c cancers in the era of widespread prostate specific antigen (PSA) testing were determined, and the ability of pretreatment parameters to predict tumor significance in men with stage T1c disease was evaluated. MATERIALS AND METHODS: Of 336 men with stage T1c prostate cancer seen between 1994 and 1996, 240 (71.4%) were treated with radical prostatectomy, 20 (6%) with radiation therapy and 76 (22.6%) expectantly. Recommendations for treatment were based on previously determined criteria predictive of a significant stage T1c cancer (more than 0.2 cm.3): 1) PSA density 0.15 ng./ml./gm. or more, 2) Gleason score 7 or greater, 3) 3 or more cores involved with cancer, or 4) 50% or more involvement of any core with cancer. Pathological evaluation of prostatectomy specimens allowed classification of tumors as insignificant (confined tumor smaller than 0.2 cm.3 with a Gleason score of less than 7), minimal (confined tumor 0.2 to less than 0.5 cm.3 with a Gleason score of less than 7), moderate (0.5 cm.3 or larger disease, or capsular penetration with a Gleason score of less than 7) and advanced (capsular penetration with a Gleason score of 7 or more, or positive margins, seminal vesicles or lymph nodes). Pathological characteristics of tumors in this series were compared to a previous series of 157 men with stage T1c cancers who underwent radical prostatectomy between 1988 and 1992. RESULTS: Of 240 men who underwent radical prostatectomy tumors were insignificant in 40 (17%), minimal in 29 (12%), moderate in 124 (52%) and advanced in 47 (19%). An increase in organ confined cancers (51 to 72%) and a decrease in positive margins (17 to 8%) were noted when comparing stage T1c series (1988 to 1992 versus 1994 to 1996) but the percentage of insignificant tumors remained stable (16 versus 17%) between series. Ultrasound and sextant biopsies were available for review in 72 cases (current series). If the pretreatment criteria used to recommend therapy suggested significant tumor (64 cases) then insignificant tumor was present in only 10 (16%). If pretreatment criteria suggested insignificant tumor (8 cases), insignificant or minimal tumor was present in 6 (75%) and moderate organ confined disease was present in 2 (25%). The absence of a lesion on ultrasound and measurement of total length of cancer within the biopsy specimen were not predictive of an insignificant tumor. CONCLUSIONS: In a nonscreened population stage T1c cancers are being discovered earlier with widespread PSA testing. Even with the detection of earlier cancers we demonstrated that it is possible to minimize the number of patients with small tumors who will undergo radical prostatectomy using pretreatment criteria to counsel men regarding appropriate management options.

Adenocarcinoma↗
PubMed1997

Granulomatous prostatitis on needle biopsy.

OBJECTIVE: To assess pathologic findings of granulomatous prostatitis (GP) on needle biopsy. DESIGN: Ninety-four cases of granulomatous prostatitis were culled from 25,852 (incidence 0.36%) consecutive men who underwent needle biopsy; clinical correlations were obtained for 75. Cases were categorized as nonspecific (NSGP, 77.7%), infectious (IGP, 18.1%), or indeterminate (4.3%) granulomatous prostatitis based on histologic and clinical criteria. SETTING: Consecutive cases from a large commercial laboratory and consultation cases. RESULTS: All cases of IGP had a history of prior bacillus Calmette-Guerin therapy for transitional cell carcinoma. Histologically, 57% of NSGP cases mimicked infection and 4% mimicked cancer. Caseating necrosis was identified in 76% of cases of IGP. Significant numbers of eosinophils were found in 68% of NSGP cases, but in only 12% of IGP cases. In no case was eosinophilia documented in peripheral blood. Multinucleated giant cells were absent or rare in 69% of NSGP cases. Significant numbers of neutrophils were found in 53% of NSGP cases, but in only 29% of IGP cases. At the time of biopsy, cancer was clinically suspected in 55% of cases categorized as NSGP and 73% categorized as IGP. Serum prostate-specific antigen ranged from less than 0.5 ng/mL to 114 ng/mL (mean 12.7 ng/mL) in NSGP and from 0.9 ng/mL to 9.7 ng/mL (mean 4.2 ng/mL) in IGP. Digital rectal exam was abnormal in 69% and 91% of NSGP and IGP cases, respectively. Transrectal ultrasound was abnormal in 77% and 100% of NSGP and IGP cases, respectively. There was no correlation between the extent of core involvement with either clinical impression, prostate-specific antigen levels, transrectal ultrasound, or digital rectal exam. Thirty additional granulomatous prostatitis cases on needle biopsy were obtained from the consultation files of one of the authors. The major difference in this group was a higher percentage of cases histologically mimicking cancer (20%); two cases were misdiagnosed by the referring pathologist as high-grade cancer. CONCLUSIONS: While NSGP is the most common granulomatous prostatitis seen on needle biopsy, bacillus Calmette-Guerin granulomas are not seen infrequently. Lesser known histologic features of NSGP were the frequent finding of neutrophils and eosinophils and infrequent multinucleated giant cells. Granulomatous prostatitis may be clinically indistinguishable from cancer, and NSGP may also histologically mimic carcinoma.

Adult↗
PubMed1996

High-density mapping of chromosomal arm 1q in renal collecting duct carcinoma: region of minimal deletion at 1q32.1-32.2.

Collecting duct carcinoma (CDC) of the kidney is a rare malignant neoplasm of distal nephron origin. Previous studies of CDC have shown loss of heterozygosity on chromosomal arm 1q in 57% of the cases studied. To better characterize 1q loss in CDC, we performed high-density mapping of the entire long arm of chromosome 1 in 13 CDC tumor samples. We observed complete deletion of chromosomal arm 1q in 5 samples and partial deletion in 4 additional tumors. Our study further showed that the region of minimal deletion is located at 1q32.1-32.2. Sixty-nine percent (9 of 13) of the tumors showed loss of heterozygosity in this area. These data suggest that a gene or group of genes that contribute to the development of distal nephron tumors may be located within the 1q32.1-32.2 region.

Chromosome Deletion↗
PubMed1996

An uncertain role for p53 gene alterations in human prostate cancers.

Inactivation of the p53 gene has been implicated in prostate cancer progression. To determine the role of p53 inactivation in the progression of clinical prostatic carcinomas, we assessed 67 tumors derived from patients with clinically localized disease for chromosome 17p and p53 gene allelic loss, p53 gene mutations using single-strand conformational polymorphism and direct sequencing, and p53 protein expression using immunohistochemical staining. Of 55 informative tumors, 10 demonstrated loss of 17p or the p53 gene; however, only a single tumor had a mutation in its remaining p53 allele. Significant p53 overexpression was observed in 2 of 38 tumors, and 9 others had faint staining of a few nuclei ( < 1%). p53 overexpression occurred in no informative tumor with allelic loss or mutation. In a 1-7-year follow-up, positive immunohistochemical staining did not confer an increased risk of recurrence (risk of recurrence, 0.86, P = 0.78), whereas allelic loss of chromosome 17p appeared to be highly correlated with recurrence (risk of recurrence, 3.7, P = 0.003). In an unrelated group of 42 patients with metastatic prostate cancer, p53 overexpression was found in 26 tumors (62%), and 15(36%) had high grade staining. Neither the presence nor the degree of expression correlated with time to progression or time to death. This series suggests that p53 gene inactivation is rare in primary prostatic tumors, not essential to the development of prostate cancer metastases, and of limited use as a prognostic marker in patients with primary or metastatic disease. Another gene or genes on chromosome 17p may be involved in prostate cancer progression.

Base Sequence↗
PubMed1996

The diagnosis and reporting of adenocarcinoma of the prostate in core needle biopsy specimens.

BACKGROUND: There has been relatively little written on the diagnosis and reporting of adenocarcinoma of the prostate diagnosed in core needle biopsy specimens. METHODS: This article reviews issues concerning diagnosing, grading, and quantification of prostate carcinoma in core needle biopsy specimens. RESULTS: The diagnosis of prostate carcinoma in core needle biopsy specimens is discussed, including the relative frequency and utility of various architecture, cytologic, and ancillary features. Grading of prostate carcinoma in core needle biopsy specimens is evaluated along with the relationship of core needle biopsy grade to corresponding radical prostatectomy grade. The relationship between the extent of carcinoma in core needle biopsy specimens to extent of tumor in the radical prostatectomy is summarized. Finally, this article summarizes articles supporting the use of high molecular weight cytokeratin in the diagnosis of adenocarcinoma of the prostate in core needle biopsy specimens. CONCLUSIONS: Pathologists are not only called upon to diagnose limited cancer in core needle biopsy specimens, but also to quantify and grade these cancers accurately. Issues relating to this pathologic evaluation are critical for physicians treating men with adenocarcinoma of the prostate.

Adenocarcinoma↗
PubMed1996

Genetic alterations in untreated metastases and androgen-independent prostate cancer detected by comparative genomic hybridization and allelotyping.

A newly developed method of comparative genomic hybridization (CGH) employing quantitative statistical comparisons was applied to DNA from two different types of advanced prostate cancer tissue. Multiple CGH analyses were obtained for each chromosome in each tumor, and the results of point-by-point comparison of the mean tumor:normal color ratio to a control normal:normal color ratio in each of 1247 evenly distributed data channels constituting the entire human genome were interpreted as loss, gain, or no change in copy number in the tumor genome. Group I tissue was obtained from prostate cancer metastases from 20 patients, 19 of whom had received no prior prostate cancer treatment. This DNA also was analyzed by Southern and microsatellite allelotyping at 53 different loci on 20 different chromosome arms. CGH results agreed with allelotyping results at 92% of the informative loci studied. These samples, which contained highly enriched tumor DNA, showed the highest rates of alteration yet reported in several chromosomal regions known to be altered frequently in prostate cancer: 8q gain (85%), 8p loss (80%), 13q loss (75%), 16q loss (55%), 17p loss (50%), and 10q loss (50%). Group II tissue was obtained predominately from primary or recurrent tumor from 11 patients who had been treated with long-term androgen-deprivation therapy and developed androgen-independent metastatic disease. Quantitative CGH analysis on DNA from these tissues showed chromosomal alterations that were very similar to those found in group I, suggesting that untreated metastatic tumors contain the bulk of chromosomal alterations necessary for recurrence to occur during androgen deprivation. In the entire data set, a number of previously undetected regions of frequent loss or gain were identified, including losses of chromosomes 2q (42%), 5q (39%), 6q (39%), and 15q (39%) and gains of chromosomes 11p (52%), 1q (52%), 3q (52%), and 2p (45%). Chi-squared analysis showed a significantly higher frequency of gain of the 4q25-q28 region in tumors from African-American patients, indicating a possible oncogene whose activation may play a role in the higher rate of progression seen in this ethnic group. Additional study of these frequently altered regions may provide insight into the mechanism of prostate cancer progression and lead to important tools for tumor-specific prognosis and therapy.

Adult↗
PubMed1996

Distal nephron renal tumors: microsatellite allelotype.

Tumors of varying malignant potential arise from the complex epithelial lining of the nephron. Although the molecular characteristics of renal clear cell carcinomas, which arise from the proximal tubule, have been studied, little is known about tumors that develop from other parts of the renal tubular system. To elucidate common molecular lesions that may contribute to the development or progression of nonproximal tubule renal tumors, we performed a detailed microsatellite allelotype of lesions thought to arise from the renal collecting duct. Eighteen collecting duct carcinomas (CDCs) and 13 renal oncocytomas were studied using highly informative microsatellite markers on all autosomal arms. Loss of heterozygosity (LOH) was identified on multiple chromosomal arms in CDCs and renal oncocytomas. Microsatellite analysis revealed LOH of 1q in 57% of informative CDCs. LOH was also observed on arms 6p (45%), 8p (40%), and 21q (40%). In renal oncocytomas, LOH of 1q occurred in approximately 30% of tumors, but 1p LOH was observed in 57% of informative cases analyzed. High levels of LOH were also observed on arms 8p, 14q, 19q, and 21q in the oncocytomas studied. Loss of chromosomal arm 3p was infrequent in both tumor types. Our results suggest that the molecular events that contribute to the development of distal nephron tumors are distinct from those associated with the etiology of proximal tubule renal cancers.

Adenoma, Oxyphilic↗
PubMed1996

Characterization of prostatic basal cell hyperplasia and neoplasia in aged macaques: comparative pathology in human and nonhuman primates.

There are very few reports of proliferative prostatic lesions occurring spontaneously in nonhuman primates. We found that 15 of 19 glands in aged macaques contained one or more epithelial lesions in the cranial lobe. These originated in the basal cell compartment and were characterized as hyperplasia and benign neoplasia. The adenomas contained variable gland formation, with morphologic and immunohistochemical evidence of secretory, mucigenous, neuroendocrine, transitional, and squamous cell differentiation. These cell types are resident in the normal prostate or appear in metaplastic lesions, and their presence in the macaque tumors is consistent with differentiation of a stem cell along multiple phenotypic pathways. The macaque growths are similar to human prostatic basal cell lesions and could provide insights into their pathogenesis as well as cellular ontogeny and general mechanisms of carcinogenesis in this organ.

Aging↗
PubMed1996

Neuroendocrine differentiation in prostate cancer: enhanced prediction of progression after radical prostatectomy.

It is controversial whether neuroendocrine (NE) differentiation in adenocarcinoma of the prostate is associated with more aggressive behavior. Most studies included patients with tumors of a wide range of grades and stages and an end point of disease-specific survival, a relatively insensitive marker of progression. The authors studied completely embedded radical prostatectomy specimens from 104 patients with clinically organ-confined carcinoma and no history of adjuvant or neoadjuvant therapy. Progression was marked by a serum prostate-specific antigen (PSA) concentration greater than or equal to 0.2 ng/mL. Seventy-six men did not progress, with a mean follow-up period of 8.0 years (range = 7 to 10 years). Forty-eight men progressed at a mean time after surgery of 3.6 years (range = 1 to 8 years). Twenty-one percent of the tumors were organ confined: 79% had capsular penetration. Seminal vesicles and lymph nodes were negative in all cases. A representative section through the main tumor mass was stained for chromogranin A. Reactive neoplastic cells were counted subjectively as well as individually enumerated. Gleason grade, pathological stage, and degree of NE differentiation all correlated with progression. Only grade and extent of NE differentiation predicted progression in a multivariate analysis. NE differentiation did not correlate with stage or grade. Extent of NE differentiation separated patients (59 cases) with tumors of Gleason sum less than or equal to 6 into groups with high and low risks for progression (P < .008) independent of Gleason sum. Extent of NE differentiation provides prognostic information in addition to that provided by grade in cases of early prostate cancer treated by radical prostatectomy.

Cell Differentiation↗
PubMed1996

Histopathologic characterization of hereditary benign prostatic hyperplasia.

OBJECTIVES: Recent studies suggest the presence of a hereditary form of benign prostatic hyperplasia (H-BPH). This study was undertaken to characterize the histopathologic features of BPH in these men. METHODS: Because study subjects with H-BPH were young (mean age 59 years) and had a large prostate (mean prostate weight 61 g), we compared the histopathologic findings in these men with those in two different control groups: (1) age-matched control subjects (mean age 59 years; mean prostate weight 31 g), and (2) prostate weight-matched control subjects (mean age 70 years; mean prostate weight 61 g). Using a color video image analysis system, we morphometrically determined stromal/epithelial ratios in histologic sections taken from 12 men with H-BPH, 36 age-matched control subjects, and 36 prostate weight-matched control subjects. RESULTS: The stromal/epithelial ratio was 2.6 +/- 1.4 in the men with H-BPH, 2.7 +/- 1.7 in the age-matched control subjects, and 1.7 +/- 0.9 in the prostate weight-matched control subjects. Regression analysis, which controlled for the differences in prostate weight or patient age between men with H-BPH and age-matched and prostate weight-matched control subjects, respectively, revealed a significant difference between men with H-BPH and prostate weight-matched control subjects (P = 0.015) but no difference from age-matched control subjects (P = 0.36). CONCLUSIONS: The larger prostates in young men with H-BPH are characterized by a higher stromal/epithelial ratio than are similar-sized prostates in older men with sporadic BPH. This finding gives rise to speculation that H-BPH is associated with an increase in stromal elements.

Adult↗
PubMed1996

Ability to predict biochemical progression using Gleason score and a computer-generated quantitative nuclear grade derived from cancer cell nuclei.

OBJECTIVES: To determine the ability to predict prostate cancer progression using shape, size, and chromatin texture nuclear grading features preselected by logistic regression analyses based on expert-selected prostate cancer cell nuclei captured using a computer-assisted image analysis system. METHODS: One hundred fifteen patients with clinically localized prostate cancer were identified at the Johns Hopkins medical institutions. The mean follow-up period was 10.4 +/- 1.7 years in 70 patients without disease progression, whereas the mean time to progression for the entire group was 3.8 +/- 2.5 years. Using 5-microns Feulgen-stained tissue sections, approximately 150 cancer cell nuclei were selected and captured for each case using a CAS-200 Image Analysis System. Thirty-eight different nuclear morphometric descriptors (NMDs) were calculated for each cell nucleus. The variance of the NMDs for each tumor was examined by univariate and multivariate logistic regression analyses and by Cox survival analyses to assess their ability to predict prostate cancer progression. RESULTS: Postoperative Gleason scoring was significantly correlated with disease progression (P < 0.00001; sensitivity, 73%; specificity, 84%; receiver operating characteristic curve area under the curve (ROC-AUC), 83%). Using backward stepwise logistic regression at a stringency of P < 0.05, the variances of 11 of the NMDs were found to be multivariately significant for progression prediction (P < 0.00001; sensitivity, 78%; specificity, 83%; ROC-AUC, 86%). A single value, termed the quantitative nuclear grade (QNG), was created from the variances of these, 11 multivariately significant NMDs using the logistic regression function. The QNG and the postoperative Gleason score were combined to create a model for the prediction of progression having a sensitivity of 89%, specificity of 84%, and ROC-AUC of 92%. These two parameters (QNG and Gleason score) clearly separated the patient sample into three statistically distinct risk groups and predicted the time to progression on the basis of Kaplan-Meier survival probability analysis. CONCLUSIONS: The QNG, combined with the postoperative Gleason score, may assist in the more accurate stratification of patients undergoing radical prostatectomy into low-, moderate-, and high-risk groups for cancer recurrence and may permit the early initiation of adjuvant therapy.

Adult↗
PubMed1996

The role of free/total prostate-specific antigen ratio in the prediction of final pathologic stage for men with clinically localized prostate cancer.

OBJECTIVES: The combined use of total prostate-specific antigen (PSA), clinical stage, and Gleason score accurately predicts final pathologic stage for men with clinically localized prostate cancer. Recently, the free/ total PSA ratio has been proposed as an adjunct for early detection of prostate cancer. We examined the association between free/total PSA and pathologic stage. METHODS: In a prospective study, 301 consecutive men with clinically localized prostate cancer (average age 58.8 years, range 45-72) underwent a staging pelvic lymphadenectomy and radical prostatectomy. Total PSA and free PSA were measured from preoperative sera. Pathologic stage was determined as organ-confined (OC, n = 169), capsular penetration (CP+, n = 108), seminal vesicle involvement (SV+, n = 13) and lymph node involvement (LN+, n = 11). RESULTS: Overall, 292/301 (97%) of the free/total PSA values were < 25%, and thus suspicious for prostate cancer. Combination of total PSA, Gleason score, and clinical stage predicted well OC (P = 0.00001) and LN+ (P = 0.023); whereas, replacing total PSA with free/total PSA ratio did not improve the prediction of OC (P = 0.0007) nor LN+ (P = 0.03). CONCLUSIONS: The free/total PSA ratio cutoff point of 25% had high sensitivity for prostate cancer among a group of men with clinically localized disease. The free/total PSA ratio did not significantly improve the prediction of pathologic stage provided by total PSA when used alone or in combination with Gleason score and clinical stage. These preliminary data demonstrate that free/total PSA levels provide no additional information for pathologic stage prediction when combined with Gleason score and clinical stage in men with clinically localized prostate cancer.

Aged↗
PubMed1996

Incidence and significance of positive margins in radical prostatectomy specimens.

This article discusses how the incidence of positive margins may be affected by patient selection, technical differences in performing radical prostatectomy, and processing and analysis of radical prostatectomy specimens. The various sites of positive margins and capsular incision are reviewed. Whether frozen sections should be used to assess margins is discussed, and the relation of margin positivity to progression following radical prostatectomy is evaluated.

Disease Progression↗
PubMed1996

Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up.

We studied 721 men with clinically confined disease who underwent radical prostatectomy. No patient received preoperative or postoperative radiotherapy or hormone therapy until progression occurred. For those men without progression, the mean follow-up was 6.5 years with a median of 6 years (range 1 to 12 years). Because patients with lymph node metastases or seminal vesicle invasion had such a high risk of progression, enhanced prognostication was not needed in men with these findings. Thus we focused this analysis on the 617 men without lymph node metastases or seminal vesicle invasion. In the multivariate analysis, Gleason score (P < 0.0001), surgical margins (P = 0.004), and capsular penetration (P = 0.007) were all independent predictors of progression. Tumors with a Gleason score of 2 through 4 were almost invariably cured, with a 10-year progression-free risk of 96%. At the opposite end of the spectrum, the 10-year actuarial progression-free risk for men with a Gleason score of 8 through 9 was 35%. Men with Gleason score 2 through 4 or 8 through 9 tumors could not be stratified into different risks of progression based on the presence or extent of capsular penetration or margin status. For the men with Gleason score 5 through 7 tumors (88.2% of cases), predicting their risk of progression was enhanced by knowledge of their tumor's capsular penetration and margin status. Tumors with a Gleason score of 5 through 6 and 7 were each stratified into three groups with different risks of progression. Using the actuarial curves within this study, physicians will be able to more accurately determine a patient's risk of progression following radical prostatectomy based on a combination of the radical prostatectomy Gleason score, extent of capsular penetration, and status of surgical margins of resection.

Disease Progression↗
PubMed1996

Prostatic carcinoma with abundant xanthomatous cytoplasm. Foamy gland carcinoma.

Foamy gland carcinoma, an unusual variant of prostate carcinoma, is characterized by abundant xanthomatous cytoplasm. We studied 38 needle biopsies in which at least one core contained cancer with >20% foamy morphology. On average, each cancer was 72% foamy, and 11 cancers were entirely foamy. In addition to the characteristic cytoplasm, 20 cases had abundant intraluminal dense pink amorphous secretions. Nuclear enlargement and prominent nucleoli were either absent of rare in 23 (61%) and 27 (71%) of foamy gland carcinomas, respectively. High-molecular-weight cyto-keratin stains were done in 20 cases; 19 foamy gland carcinomas were negative, confirming the diagnosis of carcinoma and one case had keratin staining inconsistent with a known benign pattern. Of the 27 cases with associated ordinary gland carcinoma on needle biopsy, 26 (96%) were Gleason sum greater than 4. Subsequent radical prostatectomy (RP) and transurethral resection demonstrating cancer were available in 17 cases. Of the 15 subsequent RPs, only five were organ-confined and only one was Gleason sum less than 5. The cancers in the RP group ranged from 1 to 90% foamy (mean, 39%). Foamy gland carcinoma must be recognized as carcinoma by its abundant foamy cytoplasm, its architectural pattern of crowded or infiltrative glands, and frequently present pink acellular secretions. The more typical features of adenocarcinoma, nuclear enlargement and prominent nucleoli, are frequently absent. Its relatively benign cytology makes this lesion difficult to recognize as carcinoma; 74% of our cases were seen in consultation. Despite its benign cytology, foamy gland carcinoma is best classified as intermediate-grade carcinoma.

Adenocarcinoma↗
PubMed1996

Clinical and cost impact of second-opinion pathology. Review of prostate biopsies prior to radical prostatectomy.

Despite numerous studies evaluating second-opinion surgical programs, we are unaware of work evaluating the cost effectiveness of a second opinion for pathology prior to surgery. One of six pathologists reviewed the pathology of the outside needle biopsies of 535 consecutive men referred to Johns Hopkins Hospital for radical prostatectomy over a 12-month period (from October 1993 until October 1994) before the men underwent surgery. Of the 535 needle biopsies initially diagnosed on the outside as adenocarcinoma of the prostate, seven (1.3%) were reclassified as benign upon pathology review at Johns Hopkins Hospital. The most common lesion misinterpreted as adenocarcinoma was adenosis or less pronounced examples of adenosis consisting of foci of crowded glands (five cases). Foci of atrophy in the remaining two cases were misdiagnosed as adenocarcinoma of the prostate. Upon subsequent clinical work up, six of seven men were considered not to have adenocarcinoma, and their surgery was cancelled. The cost for reviewing all 535 preoperative needle biopsies was $44,883, which included the cost of immunohistochemical studies for high-molecular-weight cytokeratin and repeat biopsies and ultrasounds in men whose diagnoses were reversed. The total cost of the radical prostatectomies had the six men undergone surgery was estimated at $85,686, including hospitalization, anesthesia, radical prostatectomy pathology, and surgery. This cost savings did not include other costs resulting from lost wages, morbidity, or potential litigation. Second-opinion pathological evaluation of prostate biopsy before radical prostatectomy is cost effective and has a major impact on clinical treatment for a subset of patients.

Adenocarcinoma↗