Blackwell Science, LtdOxford, UKIJUInternational Journal of Urology0919-81722004 Blackwell Publishing Asia Pty LtdOctober 20041110925927Case ReportProstate amyloidosisN Lawrentschuk et al.
International Journal of Urology (2004) 11, 925–927
Case Report
Implications of amyloidosis on prostatic biopsy NATHAN LAWRENTSCHUK, DAVID PAN, ROSS STILLWELL AND DAMIEN M. BOLTON Department of Surgery, Division of Urology, Austin and Repatriation Medical Center, University of Melbourne, Melbourne, Australia Abstract
Transrectal ultrasound-guided biopsy of the prostate is an integral step in the investigation of patients at risk of prostate adenocarcinoma. With an increasing number of biopsies being performed, uncommon forms of prostatic pathology will be identified more frequently. Amyloidosis of the prostate and/or the seminal vesicles may be noted on transrectal ultrasound-guided biopsy of the prostate and the implications of this histological diagnosis must be understood. We present our experience of two such cases of amyloidosis and review the literature regarding their management.
Key words
amyloid, prostate, prostate-specific antigen, seminal vesicles.
Introduction Amyloidosis of the prostate is a rare disease. With more patients undergoing transrectal ultrasound (TRUS) guided biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis increases. The initial indication for prostatic biopsy is often based on an unexplained raised serum prostatespecific antigen (PSA) level, with or without suspicious digital rectal examination findings. The place of TRUS biopsy diagnosed amyloidosis in accounting for an elevated serum PSA level has not previously been reviewed. Amyloidosis is a disease characterized by tissue deposition of rigid, non-branching fibrils having a twisted b-pleated sheet confirmation. Fibrils may be derived from various proteins by differing pathological mechanisms.1 Amyloidosis may be systemic or localized. We report on two cases of amyloidosis found on TRUS-guided prostatic biopsy and review the relevant literature.
Case reports Case 1
A 70-year-old gentleman presented for assessment of moderate obstructive voiding symptoms. He had a Correspondence: Nathan Lawrentschuk MD, 10 Mary Street, Beaumaris, Victoria 3193, Australia. Email:
[email protected] Received 25 November 2003; accepted 16 March 2004.
known history of systemic amyloidosis (untreated) and the rest of his history was otherwise unremarkable. Examination per rectum revealed a nodular, firm prostate, suspicious for carcinoma. His PSA level was raised at 7.1 mg/L (normal,
