Case 711 -- A 72 year old man with elevated PSA

Contributed by Ryan A. Collins, MD and Anil V. Parwani, MD, PhD

A maximum of 0.5 AMA PRA Category 1 Credits are available from a quiz on this case from the University of Pittsburgh's Internet-based Studies in Education and Research. Please review the case before taking the quiz.


The patient is a 72 year old man who presents for evaluation of elevated serum PSA (Prostate Specific Antigen). His most recent PSA was 10.1 ng/ml, and he has a history of PSA <1 ng/ml (4 years ago=0.77 ng/ml, 2 years ago=0.7 ng/ml). He has no signs or symptoms of prostate enlargement, including nocturia, changes in voiding, or daytime frequency. He denies prior urologic surgery. The patient does have a family history of prostate cancer, with his brother being diagnosed at age 72.


The needle core biopsies from the patient demonstrate areas of hypercellularity, with densely packed cells, hyperchromatic nuclei, and cribriform architecture (Figs. 1, 2). Additionally, areas of cellular sheets are identified with apparent loss of architectural features (Fig. 3). Regions with intraductal papillary projections, with clear cytoplasm and closely packed nuclei, are also identified (Fig. 4).

The results of PIN4 immunostains (Figs. 1a, 2a, 3a) are summarized in Table 1:

The results of PIN4 immunostains (Fig. 4a) for the structure identified in Fig 4 are summarized in Table 2:


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