Prostate Biopsy Interpretation

During the past few years, there has been an explosion of interest among pathologists for new morphologic entities of the prostate that were practically unknown or poorly understood only a few years ago. Not too long ago, the role of the pathologist when encountering prostatic specimens was to decide whether a given sample was normal, contained hyperplasia, or contained carcinoma. Today, there is a large number of keen observers of the prostatic pathology who have described in detail a whole spectrum of entities and practically polished and redefined our morphologic understanding of the prostate. Therefore, each time a pathologist looks at a slide of prostate, he or she engages in a more complex mental exercise than previously because it is now more likely to have a broader differential diagnosis than normal prostate, hyperplasia, or carcinoma. One of these keen observers is Dr. Epstein from the Department of Pathology and Urology at Johns Hopkins University School of Medicine. The second edition of his book, Prostnte Biopsy Iiiterpretntion, highlights how complex and variegated the pathology of the prostate is becoming. This is supported by the fact that in the less than 6 years since publication of the first edition, the book now contains 16 chapters, up from 11 in the first edition, and the contents of the book has also increased from 241 to 264 pages. It describes, for the most part, every topic that a pathologist may encounter in a busy practice. In addition, and in what is probably the most remarkable aspect of this book, there is an abundance of photomicrographs, which totaling 297 and average 1.12 photographs per page. Each of these occupies half of a page. These include 39 color plates of sharp quality as well. This book is easy to read as it is a very comprehensive summary of the current literature and reflects Dr. Epsteins's experience from the large consultation service he leads. The first three chapters of the book are devoted to the normal, hyperplastic, inflammatory, and non-neoplastic features of the prostate. Although the sets of photographs are very supportive of the text, there is no diagram of the normal prostate to illustrate the anatomic landmarks. In subsequent chapters, Dr. Epstein elaborates on common topics, such as prostatic intraepithelial neoplasia, grading of prostatic adenocarcinomas, diagnosis of adenocarcinoma on needle biopsy, and evaluation of transurethral resection specimens for prostatic adenocarcinoma. The chapters dealing with these topics are very well written, making the acquisition of this book a worthwhile expense. The remaining third of the book deals with entities that a general surgical pathologist may occasionally encounter in daily practice, including prostatic duct adenocarcinoma, neuroendocrine differentiation in the benign and malignant prostate, effects on prostatic tissue following treatment, basaloid lesions of the prostate, transitional cell carcinoma, mesenchymal tumors, and miscellaneous and prostatic urethral lesions. The strength of this book is also represented by the persistent emphasis throughout the text on the differential diagnosis of adenocarcinoma, particularly in the sections dealing with adenosis, mimickers of prostatic intraepithelial neoplasia and the diagnosis of needle biopsies and transurethral resection specimens. In fact, discussions on adenosis and prostatic intraepithelial neoplasia are remarkably carried out and expanded in comparison to the previous edition, thus reflecting once again the explosion of interest in prostatic pathology within the past few years. Other morphologic features arc also mentioned, illustrated, and expanded, including the hyaline sheath-like structure in sclerosing adenosis, roman bridges in prostatic intraepithelial neoplasia, and atypical basal cell hyperplasia. Another exciting aspect of this book is that it shows how the role of the pathologist is enhanced to help urologists in the management and staging of patients. Pathologists 'are being called on not only to diagnose adenocarcinoma of the prostate, but also to quantify its extent. This is true when adenocarcinoma is incidentally found on transurethral resection specimens in which the pathologist has to determine whether or not a given