Differential diagnosis of prostate cancer

Prostate cancer is a malignant disease that should be detected and treated early. Therefore, it must be differentiated from other diseases to make a clear diagnosis.

(1) It should be differentiated from prostatic hyperplasia:

The two are generally easy to distinguish. However, in the hyperplastic prostate glands, the epithelial cells in some areas are atypical in morphology and can be mistaken for cancer. The key points of the difference are: the alveoli in the hyperplastic glands are larger, the surrounding collagen fiber layer is intact, the epithelium is double-layered and high columnar, the cell nucleus is smaller than that of prostate cancer patients and is located at the base of the cell, and the glands are arranged regularly to form obvious nodules.

(2) Differentiation from prostate atrophy:

Prostate cancer often starts from the atrophic part of the gland, so it should be carefully identified. Atrophic alveoli are sometimes tightly clustered, atrophic and smaller, and the epithelial cells are cubic with large nuclei, which looks very much like cancer. However, this type of atrophy often involves the entire lobule, the collagen connective tissue layer is still intact, the matrix is ​​not invaded, but it itself is sclerotic and atrophic.

(3) Differentiation from prostatic squamous epithelium or transitional epithelium metaplasia:

It often occurs in the healing part of the infarct area within the gland, with well-differentiated squamous epithelium or transitional epithelium without degeneration or split phase. The most prominent feature of metaplasia is ischemic necrosis or fibrous connective tissue matrix lacking smooth muscle.

(4) Granulomatous prostatitis:

The cells are large and can aggregate into sheets. They have transparent or light red stained cytoplasm and small vesicular nuclei, which are very similar to prostate cancer, but are actually macrophages. Another type of cells are polymorphic, with condensed and vacuolated nuclei, small in size, arranged in rows or clusters, and sometimes some acini can be seen. When distinguishing, it should be noted that granulomatous prostatitis rarely forms acini, and the relationship between the lesions and normal glandular ducts remains unchanged. Degenerative amyloid bodies and multinucleated giant cells are often seen. The cells of prostate cancer are low columnar or cubic, with clear cell walls, dense eosinophilic cytoplasm, larger nuclei than normal, and may have variations in staining and morphology, and inactive division. Its acini are small, lack of convoluted tubules, and completely lose their normal arrangement morphology. They infiltrate irregularly into the matrix, and the collagen connective tissue layer no longer exists. The acini contain a small amount of secretions, but rarely amyloid bodies. If prostate cancer undergoes obvious degeneration, the tissue structure will completely disappear, and there will be no tendency for acini to form.

(5) In addition, prostate cancer should be differentiated from prostate tuberculosis and prostate stones.