Detection of bone marrow metastases in prostate cancer: Role of trephine biopsy and Immunohistochemistry

Context: Bone marrow (BM) metastases are an integral part of tumor dissemination in many malignancies. Prostate carcinoma, which has high tendency to metastasize to bone, shown to have affinity for endosteal niche as well as tendency to compete with hematopoietic cells to home in BM. This marrow dissemination can be confidently proved by histopathological examination of BM. Aims: In this study, we are trying to detect the presence of metastases and micrometastases in BM of prostate carcinoma patients with the help of immunohistochemical markers prostate-specific antigen (PSA) and prostate-specific acid phosphatase and correlate the findings with American Joint Committee on Cancer Tumor, Node and Metastasis 7(th) (2010) classification, serum PSA, and biopsy Gleasons score. Materials and Methods: We performed BM examination and hematological workup of 11 known prostate carcinoma patients including metastatic cases also, during our study period of 1 year. The BM biopsy sections and clot sections were used to carry out immunohistochemistry. The data were analyzed by using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Results: We found that two patients were positive for metastases in BM out of the 11. Both of these patients already had metastases to other site with very high serum PSA levels. Anemia was common hematological alteration in both of them and one of them showed increased osteoblasts in the aspirate film. Conclusion: Taking into account our small sample size and short study duration, we conclude that further large sized future studies with long-term follow-up in to this BM dissemination by prostate cancer cells could open new horizons to understand the biology of metastasis of this common malignancy and also provide more effective therapeutic options as well as prognostic implications in these patients.