For almost 20 years, prostate needle biopsies have been the most common modality for diagnosing prostatic adenocarcinoma. Over time, more aggressive biopsy techniques have been employed to better define the nature of cancer in the prostate gland. Current therapeutic decision-making is highly dependent on prostate needle biopsy pathologic findings in combination with PSA measurements and clinical/imaging information.

With greater recognition of prostate cancer as largely indolent for many patients with clinically localized disease, an increasing number of patients will likely opt for active surveillance / focal therapy programs rather than radical therapy. The accurate recognition of, grading, and quantitation of prostate cancer on needle biopsies will, to a large degree, determine eligibility for such protocols.

The objective of this short course is to highlight modern prostate needle biopsy interpretation and reporting, focusing on histopathologic features of well-defined and challenging areas in prostate pathology and their clinical import. Specifically, this course will discuss: 1) Criteria for the diagnosis of minimal (limited) prostate cancer and pathognomonic features; 2) The diagnosis of small foci of atypical glands (ASAP) and the role of immunohistochemistry in evaluating an atypical focus; 3) Gleason grading of prostate cancer on needle biopsy including an approach to challenging areas such as small cribriform lesions, tertiary patterns, and borderline Gleason grade 3-4 cases, including definition of poorly-formed glands; 4) Morphologic variants of prostate cancer commonly encountered on biopsy; 5) Benign mimics of prostate cancer; 6) Diagnosis of prostatic intraepithelial neoplasia (PIN) and its benign/malignant mimics; 7) Clinical import of tumor quantitation, perineural invasion and other features for reporting on needle biopsy.

A case-based approach will be used in this course. Numerous cases will be discussed to illustrate prototypical microscopic findings as well as the wide morphological spectrum of prostate lesions. Pre-registrants will receive a website address where they can view some virtual slides and case histories prior to the course. Registrants will also receive a syllabus at the course. After the meeting, all course registrants will have access to multiple representative images used in the course along with the text portion of the syllabus on the USCAP website.

This course is designed for general pathologists, residents and fellows, as well as those with expertise in urologic pathology. Upon completion of this educational activity, participants should be able to: 1) Accurately apply the criteria for diagnosing prostate cancer on needle biopsy, recognize its variants and benign mimics and judiciously employ immunohistochemistry as an ancillary tool; 2) Employ modern Gleason grading of needle biopsy specimens, while understanding its pitfalls and watershed areas; 3) Understand the clinical implications of the key data elements of prostate needle biopsy reporting.