CYTOPATHOLOGY OF THE PROSTATE

Transrectal fine-needle aspiration biopsy (FNAB) of the prostate under digital central is a cheap and rapid method for diagnostic evaluation of palpable and non-palpable nodules, yielding high sensitivity (ca. 95%) and a low complication rate (<1%). Its specificity amounts to >97 %. The scarcity of urologists trained in the FNAB method and of pathol ogists experienced in cytology of the prostate limit the clinical appl ication so far. Besides various forms of prostatitis, five different t ypes of cancer can cytologically be differentiated. While PIN I cannot be cytologically identified, PIN II/III lesions may lead to false-pos itive diagnoses. Cytologic grading of adenocarcinomas of the prostate is of statistically proven prognostic validity and strictly correlated with its histologic counterpart. Preoperative, radiologically control led FNAB of pelvic and paraortal lymph nodes has sensitivity of ca. 86 % and specificity of 100%. It thus helps to avoid unnecessary prostate ctomies if nodal tumor spread has preoperatively been proven. Diagnost ic DNA cytometry is able to identify those prostatic cancer patients w ho do not reveal significantly increased risk of tumor progression or decreased survival probability, even without therapy (constantly and r epresentatively diploid and tetraploid patterns). Patients with ONE te traplid histograms may show detoriation of prognosis under hormonal th erapy. DNA-aneuploid prostatic cancers should not be subjected to a '' wait and see'' strategy; they do not respond to hormonal therapy.