Prostate cancer cytology is a diagnostic procedure that involves the microscopic examination of cells from the prostate gland. Pathologists analyze the characteristics of individual cells to determine if they are cancerous, benign, or atypical. The purpose of this analysis is to provide a clear picture of cellular health, which guides further diagnostic steps and treatment decisions. This test is a subspecialty of cytopathology, a field focused on diagnosing diseases by examining single cells and small cell clusters.
When Prostate Cytology is Recommended
A recommendation for prostate cytology often follows preliminary tests that suggest abnormalities in the prostate gland. One of the most common triggers is a Prostate-Specific Antigen (PSA) blood test. PSA is a protein produced by both normal and cancerous prostate cells, but elevated or rapidly increasing levels can indicate a higher probability of prostate cancer.
Another primary indicator is the result of a Digital Rectal Exam (DRE), where a physician feels the prostate for irregularities in size, shape, or texture. The discovery of hard nodules, firmness, or an asymmetrical shape can be suspicious and lead to more detailed testing. Cytology is considered when initial tests are inconclusive or when a tissue biopsy is not feasible.
When an elevated PSA level is combined with abnormal DRE findings, the suspicion of malignancy increases. In these instances, cytology provides a method for obtaining a cellular sample to confirm or rule out cancer before proceeding to more invasive procedures.
Cell Sample Collection Methods
The most prevalent method for collecting prostate cells is Fine-Needle Aspiration (FNA). This procedure involves inserting a thin, hollow needle through the rectal wall and into the prostate gland to withdraw a small sample of cells. To ensure precision, physicians use transrectal ultrasound guidance to direct the needle to specific areas, especially suspicious regions. The process is performed with local anesthesia to minimize discomfort.
Besides FNA, cells can be collected through less invasive means. One method is urine cytology, where a urine sample is examined for prostate cells. Although cancer cells from the prostate are rarely shed into the urine, this test can be useful if the cancer has grown into the urethra, but its overall value in diagnosis is limited.
A prostatic massage is another, less common, technique. In this procedure, a physician massages the prostate gland during a DRE to release prostatic fluid into the urethra. This fluid, which may contain prostate cells, is then collected and sent for laboratory analysis.
Microscopic Analysis of Prostate Cells
In the laboratory, a pathologist conducts a microscopic examination of the collected cells to identify features of malignancy. The analysis compares the submitted cells to the known characteristics of healthy prostate cells. Healthy cells display a uniform size and shape, with small, regular nuclei, and are arranged in an orderly, honeycomb-like pattern.
Malignant prostate cells, in contrast, exhibit distinct abnormalities, especially within the nucleus. The nuclei of cancer cells are larger, darker (hyperchromatic), and have irregular shapes compared to their benign counterparts. This change reflects alterations in the cell’s genetic material.
Another indicator is the prominence of nucleoli, which are small structures inside the nucleus. In normal prostate cells, nucleoli are inconspicuous or not visible, but in cancerous cells, these structures become much larger and easily identifiable. The overall arrangement of cancer cells is also telling, as they form disorganized, crowded clusters. It is important to distinguish this cellular-level analysis from histology, which examines the architecture of a larger tissue sample from a biopsy.
Interpreting the Cytology Report
The cytology report summarizes the pathologist’s findings for the patient and their doctor. The results are categorized into classifications that describe the nature of the cells. A “benign” result means that no cancerous cells were identified in the sample, suggesting the absence of malignancy.
A “malignant” diagnosis confirms the presence of cancer cells. This finding provides a definitive answer and allows the medical team to proceed with planning treatment. The report will detail the abnormal features observed in the cells that led to this conclusion.
In some cases, the report may be “atypical” or “suspicious for malignancy.” This result indicates that the cells show some abnormal characteristics, but not enough to make a definitive cancer diagnosis. This finding often necessitates further investigation, most commonly a tissue biopsy. A biopsy allows for a more detailed examination and is required to determine the cancer’s grade using the Gleason score, which helps predict how quickly the cancer may grow and spread.