The utility of PSMA and PSA immunohistochemistry in the cytologic diagnosis of metastatic prostate carcinoma

The diagnosis of metastatic prostate carcinoma frequently requires the use of immunohistochemical adjuncts. Immunohistochemistry for prostate‐specific antigen (PSA) is commonly used for this purpose but can be of limited utility. Recently, prostate‐specific membrane antigen (PSMA) has been shown to...

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Bibliographic Details
Published in:Diagnostic cytopathology 2014-07, Vol.42 (7), p.570-575
Main Authors: Bernacki, Kurt D., Fields, Kristina L., Roh, Michael H.
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnosis
Adenocarcinoma - metabolism
Adenocarcinoma - secondary
Antigens, Surface - metabolism
carcinoma
Cytodiagnosis
cytology
Glutamate Carboxypeptidase II - metabolism
Humans
Immunohistochemistry
Kallikreins - metabolism
Lymphatic Metastasis
Male
prostate-specific antigen
Prostate-Specific Antigen - metabolism
prostate-specific membrane antigen
Prostatic Neoplasms - diagnosis
Prostatic Neoplasms - metabolism
Prostatic Neoplasms - pathology
Sensitivity and Specificity
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Summary:The diagnosis of metastatic prostate carcinoma frequently requires the use of immunohistochemical adjuncts. Immunohistochemistry for prostate‐specific antigen (PSA) is commonly used for this purpose but can be of limited utility. Recently, prostate‐specific membrane antigen (PSMA) has been shown to be a promising marker for the identification of metastatic prostate carcinoma in surgical specimens. The utility of this marker has yet to be reported for cytology specimens. We sought to compare the sensitivities of PSMA and PSA immunohistochemistry and investigate the specificity of PSMA by utilizing cell block preparations from cytologic cases of metastatic prostate carcinoma (n = 19) and carcinomas of nonprostatic origin (n = 33). The sensitivity of PSMA immunohistochemistry was higher (16/19; 84%) in detecting metastatic prostate carcinomas than that of PSA immunohistochemistry (11/19; 58%). Strong, diffuse staining for PSMA was seen in 13 (81%) of 16 PSMA‐positive cases whereas strong, diffuse staining for PSA was observed in six (55%) of 11 PSA‐positive cases. Positivity for either PSMA or PSA was seen in 17 of 19 cases of metastatic prostate carcinoma for a combined sensitivity of 89%. PSMA immunohistochemistry was completely negative in 32 of 33 cytology cases of nonprostatic carcinomas. Therefore, the specificity of this marker was 97% in this study. In conclusion, our results indicate that PSMA is a highly sensitive and specific immunomarker for the detection of metastatic prostate carcinoma in cytology specimens. Diagn. Cytopathol. 2014;42:570–575. © 2013 Wiley Periodicals, Inc.
ISSN:8755-1039
1097-0339
DOI:10.1002/dc.23075