Atrophy of the prostate gland

Atrophy of the prostate gland, also prostatic atrophy, is a common change in the prostate gland.

It usually is seen focally; thus, it is sometimes called partial prostatic atrophy.

On occasion, it can mimic prostate carcinoma, especially atrophic prostate carcinoma.

General

• Small glands (may mimic Gleason score 3 pattern).
• Inflammatory atrophy seems to be related to HGPIN and prostate cancer; however, the epidemiology is not compelling that this is a significant (clinical) association.

Microscopic

Features:

• Glands often have a jagged edges/prows (in cancer the glands tend to have round edges) - key feature.
  • Prow = forward most part of a ship's bow that cuts through the water.
    • You may have come across prow in the context of breast cancer, i.e. tubular carcinoma.
• Gland density is usually lower than in prostate carcinoma, i.e. glands are not back-to-back - key feature.
• Atrophic glands are often hyperchromatic.
• Scant cytoplasm - usually.

Negatives:

• Nuclei like normal, i.e. nucleoli uncommon.
• Should have two cell layers, i.e. epithelial and myoepithelial (may be difficult to see).

Notes:

• Atrophic glands may be scattered with non-atrophic ones.
• IHC may be misleading - basal cell loss.

DDx:

• Atrophic prostate carcinoma.

Atrophy versus cancer

Histologic feature	Atrophy	Cancer
Glandular architecture/ arrangement	angulated glands, may look like they originate from one large duct	round glands, often back-to-back
Nuclear hyperchromasia	marked	moderate
Cytoplasm	scant/minimal	moderate, may be amphophilic
Basal cells	may be visible	absent
Nucleoli	absent	present
Secretions in glands	no	yes - eosinophilic or blue

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Generally, this finding is not reported; it is considered a normal finding.

See also

• Prostate gland.