PROSTATIC ATROPHY - AN AUTOPSY STUDY OF A HISTOLOGIC MIMIC OF ADENOCARCINOMA

Prostatic atrophy (PA) is one of the most frequent mimics of prostatic adenocarcinoma. It occurs almost exclusively in the peripheral zone o f the gland and gained importance with the increasing use of needle bi opsies for the detection of prostatic carcinoma. The etiopathogenesis is unknown, and there is controversy related to the potential of PA as a precancerous lesion. The frequency increases with age. Compressions caused by hyperplastic nodules, inflammation, hormones, nutritional d eficiency, or systemic or local ischemia, are all possible factors in the pathogenesis of PA. The peripheral zone of the prostate was step-s ectioned and totally embedded from the bodies of 100 consecutively aut opsied men more than 40 years of age. The fragments were microscopical ly studied for presence of PA, latent (histologic) carcinoma, high-gra de prostatic intraepithelial neoplasia, local arteriosclerosis, and pr ostatitis. The prostates were macroscopically examined for the presenc e of nodular prostatic hyperplasia The autopsy reports provided inform ation concerning the presence of generalized atherosclerosis and benig n or malignant nephrosclerosis. PA was seen in 85 of the 100 prostates examined and histologically was subtyped into simple, hyperplastic, a nd sclerotic atrophy. In 65 (76.47%) of 85 cases, the histologic subty pes were combined. In 33 (50.76%) of these 65 cases, the three subtype s were seen concomitantly, favoring the hypothesis that they represent a morphologic continuum of only one lesion. Fibrosis of the stroma ma y or may not be present in simple and hyperplastic atrophy. Hyperplast ic atrophy associated with fibrosis of the stroma is the histologic su btype that most frequently mimics adenocarcinoma Sclerotic atrophy alw ays presents fibrosis of the stroma. PA increases with age, and, in ou r study, ischemia caused by local intense arteriosclerosis seems to be a potential factor for its etiopathogenesis. Because there was no rel ation to latent (histologic) carcinoma or high-grade prostatic intraep ithelial neoplasia, PA is probably not a premalignant lesion.