Optimizing Detection of Prostate Cancer by AMACR and P63 on Prostatic Needle Biopsy- Sudanese Experience

Establishing a definitive diagnosis is the major challenge in prostatic needle biopsyespecially in small focus of cancer as there is no single specific histologic feature for malignancy or due to the presence of benign mimickers.However, the lack of specific marker for prostate cancer, which can be utilized with routine HandE to enhance diagnostic precision remains a limitation.Recently, basal cell marker P63 and prostate cancer marker AMACR have been used as adjuvant to morphology for diagnosis of such challenging foci.This study was set out to determine the sensitivity and specificity of these markers and their usefulness in differentiation between prostate adenocarcinoma and benign prostatic hyperplasia (BPH) on prostatic needle biopsy. Method: A 250 archival prostate needle biopsies during 2017–2019 were selected and sorted according to routine HandE as follow; 100 prostatic adenocarcinoma, 50 Atypical (ATYP) and 100 of BPH.Sections of 5 µm thickness were cut, then Immunohistochemistry (IHC) was performed using monoclonal AMACR and P63 antibodies and the results were analyzed using SPSS. Results: AMACR had 95% sensitivity and 98% specificity, statistically AMACR wassignificantly expressed in prostate adenocarcinoma P.value(0.000). P63 had 95% sensitivity and 95% specificity, it was significantly expressed in benign prostatic hyperplasia P. value (0.000). By IHC 38/50 atypical foci (ATYP), was confirmed as adenocarcinoma while 12/50 case reported as BPH.The study concluded that combination of AMACR as a positive marker and p63 as a negative marker will improve sensitivity, specificity and enhances diagnostic precision.