Construction of an integrated diagnostic-therapeutic model for prostate cancer using rapid multiplex immunohistochemistry.

OBJECTIVE

To explore the feasibility and clinical application value of constructing an integrated model for the diagnosis and treatment of prostate cancer based on rapid multiplex immunohistochemistry (RMI) combined with intraoperative frozen section examination (IFSE).

METHODS

A total of 50 patients with high suspicion of localized prostate cancer were prospectively enrolled at our hospital between January and November 2025. All patients underwent mpMRI/TRUS fusion‑guided transperineal targeted biopsy. Tissue specimens obtained during biopsy were processed for both IFSE and RMI. The RMI panel included antibodies against P504S, P63, 34βE12, and CK5/6. Patients with an intraoperative pathological diagnosis of prostate cancer proceeded directly to robot‑assisted laparoscopic radical prostatectomy (RARP). Those with negative intraoperative findings underwent systematic biopsy. The diagnostic performance of this model was evaluated using postoperative whole- mount histopathology or conventional pathology from systematic biopsy as the reference standard.

RESULTS

The overall pathological positivity rate in this study was 86.00% (43/50). Of these, 39 patients were intraoperatively diagnosed with prostate cancer by rapid pathology and subsequently underwent immediate RARP. IFSE alone diagnosed prostate cancer in 37 cases, with a diagnostic sensitivity of 94.87% (37/39). The concordance rate of Gleason score with postoperative pathology was 81.08%. IFSE combined with RMI diagnosed prostate cancer in all 39 cases, each later confirmed by postoperative pathology following RARP, yielding a diagnostic sensitivity of 100%. The Gleason score concordance rate improved to 97.44%. The false-negative rate was 5.13% for IFSE alone, compared to 0% for the combined IFSE and RMI approach. The mean time to obtain pathological results was 29.80 ± 3.92 minutes for IFSE alone, and 29.93 ± 2.35 minutes for IFSE combined with RMI, indicating no significant prolongation. All 39 patients who underwent immediate RARP had a mean hospital stay of 7.31 ± 1.41 days, with only one hospitalization episode per patient.

CONCLUSION

RMI effectively compensates for the limitations of IFSE alone. The combined application of IFSE and RMI within an integrated diagnostic–therapeutic model for prostate cancer significantly improves intraoperative diagnostic sensitivity and Gleason score accuracy without substantially extending waiting time.