Diagnostic utility of a p63/alpha-methyl coenzyme A racemase (p504s) cocktail in ambiguous lesions of the prostate upon needle biopsy

BJU Int. 2006 May;97(5):1109-15. doi: 10.1111/j.1464-410X.2006.06069.x.


Objective: To investigate the potential utility of a new combined immunostaining technique for diagnosing prostate cancer from histological analysis of needle biopsy specimens.

Materials and methods: Tissue was immunostained with a combination of antibodies against a basal cell marker (p63), and an enzyme commonly overexpressed in prostate cancer (p504s), on 63 small prostate cancer foci (<1 mm) and 109 cases of ambiguous lesions observed in needle biopsies.

Results: After p63/p504s immunostaining, 93% of the ambiguous lesions (102/109) were classified. The final diagnoses retained were: 92 prostate cancers, seven atypical small acinar proliferations suspected of being malignant but undiagnosed, 21 prostatic intraepithelial neoplasia, five atypical adenomatous hyperplasia, and 36 atrophic benign mimickers of cancer.

Conclusions: Combining p504s as a positive marker for prostate cancer and p63 as a negative marker might improve diagnostic performance, sensitivity and specificity, and lead to fewer false-negative results. This simple immunostaining procedure should reduce the percentage of residual ambiguous lesions and the need for additional biopsies.

Publication types

  • Evaluation Study

MeSH terms

  • Antibodies / metabolism
  • Biopsy, Needle / methods
  • Cell Transformation, Neoplastic
  • Humans
  • Immunohistochemistry / methods
  • Male
  • Membrane Proteins / metabolism
  • Prostate / pathology*
  • Prostatic Neoplasms / pathology*
  • Racemases and Epimerases*
  • Sensitivity and Specificity


  • Antibodies
  • CKAP4 protein, human
  • Membrane Proteins
  • Racemases and Epimerases
  • alpha-methylacyl-CoA racemase