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1 - Anatomy of the prostate gland and surgical pathology of prostate cancer

Published online by Cambridge University Press:  23 December 2009

By
Kai H. Hammerich ,
Gustavo E. Ayala  and
Thomas M. Wheeler
Edited by
Hedvig Hricak  and
Peter Scardino
Hedvig Hricak
Affiliation:
Memorial Sloan-Kettering Cancer Center
Peter Scardino
Affiliation:
Memorial Sloan-Kettering Cancer Center
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Summary

Introduction

Urologists and pathologists have focused more and more on the anatomic structures of the human prostate gland and their relationship to prostate carcinoma development and prognosis since the resurgence of radical prostatectomy in the late 1980s. The accessibility of whole-mount slide preparation in the study of the prostate has greatly simplified this analysis.

This chapter concentrates on the anatomy of the prostate gland and analyzes how anatomic structures relate to the origin, development, and evolution of prostate carcinoma. The concept of zonal anatomy and its role in prostate carcinoma will also be described.

Anatomy and histology of the normal prostate gland

Embryology and development of the prostate gland

During the third month of gestation, the prostate gland develops from epithelial invaginations from the posterior urogenital sinus under the influence of the underlying mesenchyme [1]. The normal formation of the prostate gland requires the presence of 5α-dihydrotestosterone, which is synthesized from fetal testosterone by the action of 5α-reductase [2]. This enzyme is localized in the urogenital sinus and external genitalia of humans [3]. Consequently, deficiencies of 5α-reductase will cause a rudimentary or undetectable prostate in addition to severe abnormalities of the external genitalia, although the epididymides, vasa deferentia, and seminal vesicles remain normal [4].

During the prepubertal period, the constitution of the human prostate remains more or less identical but begins to undergo morphologic changes into the adult phenotype with the beginning of puberty.

Type
Chapter
Information
Prostate Cancer , pp. 1 - 14
Publisher: Cambridge University Press
Print publication year: 2008

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References

Lowsley, O., The development of the human prostate gland with reference to the development of other structures at the neck of the urinary bladder. Am J Anat, 13 (1912), 299–350.CrossRefGoogle Scholar
Coffey, D., The molecular biology, endocrinology, and physiology of the prostate and seminal vesicles. In: Campbell's Urology, 6th edn., ed. Walsh, P. C., Retik, A. B., Stamley, T. A., et al., Philadelphia: W B Saunders, 1992; 49–52.Google Scholar
Wilson, J. D., Griffin, J. E., Leshin, M., et al., Role of gonadal hormones in development of the sexual phenotypes. Hum Genet, 58:1 (1981), 78–84.CrossRefGoogle ScholarPubMed
Imperato-McGinley, J., Guerrero, L., Gautier, T, et al., Steroid 5alpha-reductase deficiency in man. An inherited form of male pseudohermaphroditism. Birth Defects Orig Artic Ser, 11:4 (1975), 91–103.Google Scholar
Berry, S. J., Coffey, D. S., Walsh, P. C., et al., The development of human benign prostatic hyperplasia with age. J Urol, 132:3 (1984), 474–9.CrossRefGoogle ScholarPubMed
Kost, L. V., Evans, G. W., Occurrence and significance of striated muscle within the prostate. J Urol, 92 (1964), 703–4.CrossRefGoogle ScholarPubMed
Franks, L. M., Atrophy and hyperplasia in the prostate proper. J Pathol Bacteriol, 68:2 (1954), 617–21.CrossRefGoogle ScholarPubMed
McNeal, J. E., Anatomy of the prostate: an historical survey of divergent views. The Prostate, 1:1 (1980), 3–13.CrossRefGoogle ScholarPubMed
McNeal, J. E., Normal histology of the prostate. Am J Surg Pathol, 12:8 (1988), 619–33.CrossRefGoogle ScholarPubMed
McNeal, J. E., Normal and pathologic anatomy of prostate. Urology, 17:Suppl 3 (1981), 11–16.Google Scholar
McNeal, J. E., The prostate and prostatic urethra: a morphologic synthesis. J Urol, 107:6 (1972), 1008–16.CrossRefGoogle ScholarPubMed
Ayala, A. G., Ro, J. Y., Babaian, R., et al., The prostatic capsule: does it exist? Its importance in the staging and treatment of prostatic carcinoma. Am J Surg Pathol, 13:1 (1989), 21–7.CrossRefGoogle ScholarPubMed
Villers, A. A., McNeal, J. E., Redwine, E. A., et al., Pathogenesis and biological significance of seminal vesicle invasion in prostatic adenocarcinoma. J Urol, 143:6 (1990), 1183–7.CrossRefGoogle ScholarPubMed
Ohori, M., Scardino, P. T., Lapin, S. L., et al., The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer. Am J Surg Pathol, 17:12 (1993), 1252–61.CrossRefGoogle ScholarPubMed
Cheng, L., Bergstralh, E. J., Cheville, J. C., et al., Cancer volume of lymph node metastasis predicts progression in prostate cancer. Am J Surg Pathol, 22:12 (1998), 1491–500.CrossRefGoogle ScholarPubMed
Kothari, P. S., Scardino, P. T., Ohori, M., et al., Incidence, location, and significance of periprostatic and periseminal vesicle lymph nodes in prostate cancer. Am J Surg Pathol, 25:11 (2001), 1429–32.CrossRefGoogle ScholarPubMed
Lujan, M., Paez, A., Llanes, L., et al., Role of autonomic innervation in rat prostatic structure maintenance: a morphometric analysis. J Urol, 160:5 (1998), 1919–23.CrossRefGoogle ScholarPubMed
Watanabe, H., Shima, M., Kojima, M., et al., Dynamic study of nervous control on prostatic contraction and fluid excretion in the dog. J Urol, 140:6 (1988), 1567–70.CrossRefGoogle ScholarPubMed
Wang, J. M., McKenna, K. E., McVary, K. T., et al., Requirement of innervation for maintenance of structural and functional integrity in the rat prostate. Biol Reprod, 44:6 (1991), 1171–6.CrossRefGoogle ScholarPubMed
Walsh, P. C., Lepor, H., Eggleston, J. C., Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. The Prostate, 4:5 (1983), 473–85.CrossRefGoogle ScholarPubMed
Lepor, H., Gregerman, M., Crosby, R., et al., Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol, 133:2 (1985), 207–12.CrossRefGoogle ScholarPubMed
Walsh, P. C., Donker, P. J., Impotence following radical prostatectomy: insight into etiology and prevention. J Urol, 128:3 (1982), 492–7.CrossRefGoogle Scholar
Jemal, A., Siegel, R., Ward, E., et al., Cancer statistics, 2007. CA Cancer J Clin, 57:1 (2007), 43–66.CrossRefGoogle ScholarPubMed
Landis, S. H., Murray, T., Bolden, S., et al., Cancer statistics, 1999. CA Cancer J Clin, 49:1 (1999), 8–31.CrossRefGoogle ScholarPubMed
Villers, A., McNeal, J. E., Freiha, F. S., et al., Multiple cancers in the prostate. Morphologic features of clinically recognized versus incidental tumors. Cancer, 70:9 (1992), 2313–18.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
McNeal, J. E., Redwine, E. A., Freiha, F. S., et al., Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol, 12:12 (1988), 897–906.CrossRefGoogle Scholar
Oesterling, J. E., Brendler, C. B., Epstein, J. I., et al., Correlation of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade with final pathological stage in 275 patients with clinically localized adenocarcinoma of the prostate. J Urol, 138:1 (1987), 92–8.CrossRefGoogle ScholarPubMed
Gleason, D. F., Atypical hyperplasia, benign hyperplasia, and well-differentiated adenocarcinoma of the prostate. Am J Surg Pathol, 9:Suppl 5–6 (1985), 53–67.Google Scholar
Gleason, D. F., The Veterans Administration Cooperative Research Group. Histologic grading and clinical staging of prostatic carcinoma. In Urologic Pathology: The Prostate, ed. Tannenbaum, M., Philadelphia: Lea & Febinger, 1977; 171–4.
Bocking, A., Auffermann, W., Schwarz, H., et al., Cytology of prostatic carcinoma. Quantification and validation of diagnostic criteria. Anal Quant Cytol, 6:2 (1984), 74–88.Google ScholarPubMed
Arora, R., Koch, M. O., Eble, J. N., et al., Heterogeneity of Gleason grade in multifocal adenocarcinoma of the prostate. Cancer, 100:11 (2004), 2362–6.CrossRefGoogle ScholarPubMed
Chan, T. Y., Partin, A. W., Walsh, P. C., et al., Prognostic significance of Gleason score 3 + 4 versus Gleason score 4 + 3 tumor at radical prostatectomy. Urology, 56:5 (2000), 823–7.CrossRefGoogle ScholarPubMed
Herman, C. M., Kattan, M. W., Ohori, M., et al., Primary Gleason pattern as a predictor of disease progression in Gleason score 7 prostate cancer: a multivariate analysis of 823 men treated with radical prostatectomy. Am J Surg Pathol, 25:5 (2001), 657–60.CrossRefGoogle ScholarPubMed
Stamey, T. A., McNeal, J. E., Freiha, F. S., et al., Morphometric and clinical studies on 68 consecutive radical prostatectomies. J Urol, 139:6 (1988), 1235–41.CrossRefGoogle ScholarPubMed
Epstein, J. I., Carmichael, M. J., Pizov, G., et al., Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup. J Urol, 150:1 (1993), 135–41.CrossRefGoogle ScholarPubMed
Wheeler, T. M., Dillioglugil, O., Kattan, M. W., et al., Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1–2 prostate cancer. Hum Pathol, 29:8 (1988), 856–62.CrossRefGoogle Scholar
Greene, F. L., Page, D. L., Fleming, I. D., et al., eds. AJCC Cancer Staging Manual, 6th edn. New York: Springer-Verlag, 2002.CrossRefGoogle Scholar
Ernst, P., Uber das Wachstum und die Verbreitung Bosartiger Geschwulste insbesondere des Krebses in die Lymphbahnen der Nerven. Beitr Pathol Anat, 7:Suppl (1905), 29.Google Scholar
Ayala, G. E., Dai, H., Ittmann, M., et al., Growth and survival mechanisms associated with perineural invasion in prostate cancer. Cancer Res, 64:17 (2004), 6082–90.CrossRefGoogle ScholarPubMed
Ayala, G. E., Dai, H., Tahir, S. A., et al., Stromal antiapoptotic paracrine loop in perineural invasion of prostatic carcinoma. Cancer Res, 66:10 (2006), 5159–64.CrossRefGoogle ScholarPubMed
Villers, A., McNeal, J. E., Redwine, E. A., et al., The role of perineural space invasion in the local spread of prostatic adenocarcinoma. J Urol, 142:3 (1989), 763–8.CrossRefGoogle ScholarPubMed
Maru, N., Ohori, M., Kattan, M. W., et al., Prognostic significance of the diameter of perineural invasion in radical prostatectomy specimens. Hum Pathol, 32:8 (2001), 828–33.CrossRefGoogle ScholarPubMed
Tuxhorn, J. A., Ayala, G. E., Rowley, D. R., Reactive stroma in prostate cancer progression. J Urol, 166:6 (2001), 2472–83.CrossRefGoogle ScholarPubMed
Tuxhorn, J. A., McAlhany, S. J., Dang, T. D., et al., Stromal cells promote angiogenesis and growth of human prostate tumors in a differential reactive stroma (DRS) xenograft model. Cancer Res, 62:11 (2002), 3298–307.Google Scholar
Ayala, G., Tuxhorn, J. A., Wheeler, T. M., et al., Reactive stroma as a predictor of biochemical-free recurrence in prostate cancer. Clin Cancer Res, 15:9 (2003), 4792–801.Google Scholar
Yanagisawa, N., Li, R., Rowley, D., et al., Stromogenic prostatic carcinoma pattern (carcinomas with reactive stromal grade 3) in needle biopsies predicts biochemical recurrence-free survival in patients after radical prostatectomy. Hum Pathol, 38:11 (2007), 1611–20.CrossRefGoogle ScholarPubMed
Greene, D. R., Wheeler, T. M., Egawa, S., et al., Relationship between clinical stage and histological zone of origin in early prostate cancer: morphometric analysis. Br J Urol, 68:5 (1991), 499–509.CrossRefGoogle ScholarPubMed
McNeal, J. E.. Origin and development of carcinoma in the prostate. Cancer, 23:1 (1969), 24–34.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Moore, R. A.. The morphology of small prostatic carcinoma. J Urol, 33 (1935), 224–34.CrossRefGoogle Scholar
Greene, D. R., Wheeler, T. M., Egawa, S., et al., A comparison of the morphological features of cancer arising in the transition zone and in the peripheral zone of the prostate. J Urol, 146:4 (1991), 1069–76.CrossRefGoogle ScholarPubMed
Murphy, W. M., Soloway, M. S., Barrows, G. H., Pathologic changes associated with androgen deprivation therapy for prostate cancer. Cancer, 68:4 (1991), 821–8.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Hellstrom, M., Haggman, M., Brandstedt, S., et al., Histopathological changes in androgen-deprived localized prostatic cancer. A study in total prostatectomy specimens. Eur Urol, 24:4 (1993), 461–5.CrossRefGoogle ScholarPubMed
Helpap, B., Koch, V., Histological and immunohistochemical findings of prostatic carcinoma after external or interstitial radiotherapy. J Cancer Res Clin Oncol, 117:6 (1991), 608–14.CrossRefGoogle ScholarPubMed
Wheeler, J. A., Zagars, G. K., Ayala, A. G., Dedifferentiation of locally recurrent prostate cancer after radiation therapy. Evidence for tumor progression. Cancer, 71:11 (1993), 3783–7.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Bostwick, D. G., Egbert, B. M., Fajardo, L. F., Radiation injury of the normal and neoplastic prostate. Am J Surg Pathol, 6:6 (1982), 541–51.CrossRefGoogle ScholarPubMed
Franks, L. M., Estrogen-treated prostatic cancer: the variation in responsiveness of tumor cells. Cancer, 13 (1960), 490–501.3.0.CO;2-U>CrossRefGoogle Scholar
Ayala, G., Satoh, T., Li, R., et al., Biological response determinants in HSV-tk + ganciclovir gene therapy for prostate cancer. Mol Ther, 13:4 (2006), 716–28.CrossRefGoogle ScholarPubMed
Whitmore, Jr W. F.., Natural history and staging of prostate cancer. Urol Clin North Am, 11:2 (1984), 205–20.Google ScholarPubMed
Jewett, H. J., Significance of the palpable prostatic nodule. JAMA, 160:10 (1956), 838–9.CrossRefGoogle ScholarPubMed
Burke, H. B., Henson, D. E., The American Joint Committee on Cancer. Criteria for prognostic factors and for an enhanced prognostic system. Cancer, 72:10 (1993), 3131–5.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Bostwick, D. G., Staging prostate cancer – 1997: current methods and limitations. Eur Urol, 32:Suppl 3 (1997), 2–14.Google ScholarPubMed
Schroder, F. H., Hermanek, P., Denis, L., et al., The TNM classification of prostate cancer. Prostate Suppl, 4 (1992), 129–38.CrossRefGoogle ScholarPubMed
Ohori, M., Wheeler, T. M., Scardino, P. T., The New American Joint Committee on Cancer and International Union Against Cancer TNM classification of prostate cancer. Clinicopathologic correlations. Cancer, 74:1 (1994), 104–14.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Bubendorf, L., Schopfer, A., Wagner, U., et al., Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol, 31:5 (2000), 578–83.CrossRefGoogle ScholarPubMed
Monte, S. M., Moore, G. W., Hutchins, G. M., Metastatic behavior of prostate cancer. Cluster analysis of patterns with respect to estrogen treatment. Cancer, 58:4 (1986), 985–93.3.0.CO;2-I>CrossRefGoogle ScholarPubMed

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