Rare tumors · 2026
Diagnostic utility of Ki-67 proliferation index, PSA, and other immunohistochemical markers in prostatic basal cell carcinoma: A review of 24 cases in the current literature and discussion on current treatment and diagnostics.
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DeBinya Lister, Mathesh Vivek, Wang Jue
Аннотация
BACKGROUND: Basal cell carcinoma (BCC) of the prostate is a rare and poorly characterized malignancy distinct from conventional prostatic adenocarcinoma. Due to its rarity, diagnostic challenges arise, often leading to misclassification and delayed management. Immunohistochemical markers such as Ki-67 proliferation index and prostate-specific antigen (PSA) levels may aid in distinguishing BCC from typical adenocarcinoma, but data remain limited.
METHODS: This case series review study retrospectively analyzes published case reports and series spanning from 1988 to 2023 to evaluate Ki-67 staining patterns, PSA levels, and other immunohistochemical features to identify distinguishing characteristics of prostatic BCC. Data extracted included patient demographics, PSA levels at presentation, Ki-67 proliferation index values, and results of other immunohistochemical staining (i.e., PSA, P63).
RESULTS: Of the 24 BCC cases included in the final analysis, 20 reported PSA level at first presentation (mean: 2.56 ng/mL, range 0.08-7.3 ng/mL, normal range <4), 15 reported PSA IHC staining, and only 13 reported Ki-67 percentage values obtained through primary tumor biopsy staining (mean: 46.88%, range 0-80%). In comparison, Ki-67 expression numbers from National Comprehensive Cancer Network (NCCN) for prostate adenocarcinoma report varied Ki-67 expressions between risk groups: low-risk patients averaged 5.1% ± 3.8%, intermediate-risk patients averaged 7.4% ± 6.8%, and high-risk patients averaged 12.0% ± 12.4%. Various immunohistochemical staining was also collected yielding positive staining with Ki-67 in 13/13 cases, HMWCK/34βE12 in 14/14 cases, P63 in 14/14 cases, and BCL-2 in 12/13 cases.
CONCLUSION: This retrospective analysis suggests that prostatic BCC may be characterized by higher Ki-67 proliferation indices and lower PSA levels compared to typical prostatic adenocarcinoma. This review further explores and proposes the potential of combining Ki-67 and PSA assessments along with other biomarkers to aid in distinguishing BCC from conventional prostate cancers, facilitating earlier recognition and appropriate management of this rare malignancy.
METHODS: This case series review study retrospectively analyzes published case reports and series spanning from 1988 to 2023 to evaluate Ki-67 staining patterns, PSA levels, and other immunohistochemical features to identify distinguishing characteristics of prostatic BCC. Data extracted included patient demographics, PSA levels at presentation, Ki-67 proliferation index values, and results of other immunohistochemical staining (i.e., PSA, P63).
RESULTS: Of the 24 BCC cases included in the final analysis, 20 reported PSA level at first presentation (mean: 2.56 ng/mL, range 0.08-7.3 ng/mL, normal range <4), 15 reported PSA IHC staining, and only 13 reported Ki-67 percentage values obtained through primary tumor biopsy staining (mean: 46.88%, range 0-80%). In comparison, Ki-67 expression numbers from National Comprehensive Cancer Network (NCCN) for prostate adenocarcinoma report varied Ki-67 expressions between risk groups: low-risk patients averaged 5.1% ± 3.8%, intermediate-risk patients averaged 7.4% ± 6.8%, and high-risk patients averaged 12.0% ± 12.4%. Various immunohistochemical staining was also collected yielding positive staining with Ki-67 in 13/13 cases, HMWCK/34βE12 in 14/14 cases, P63 in 14/14 cases, and BCL-2 in 12/13 cases.
CONCLUSION: This retrospective analysis suggests that prostatic BCC may be characterized by higher Ki-67 proliferation indices and lower PSA levels compared to typical prostatic adenocarcinoma. This review further explores and proposes the potential of combining Ki-67 and PSA assessments along with other biomarkers to aid in distinguishing BCC from conventional prostate cancers, facilitating earlier recognition and appropriate management of this rare malignancy.