Malakoplakia associated with prostatic adenocarcinoma: Report of 4 cases and literature review

Ann Diagn Pathol. 2016 Jun;22:33-7

Medlicott S, Magi-Galluzzi C, Jimenez RE, Trpkov K


Malakoplakia is an inflammatory process that has been rarely reported in the prostate. Malakoplakia in association with prostatic carcinoma is exceedingly rare with only 4 previously reported cases. We describe the clinical features and the associated pathology in 4 patients who demonstrated malakoplakia of the prostate in association with prostatic adenocarcinoma. Prostatic malakoplakia presenting in association with prostatic adenocarcinoma was identified in 4 patients through a search from the records of 3 institutional databases with large in-house and consult uropathology practices. In 2 of the patients the diagnostic needle biopsy contained only prostatic carcinoma; malakoplakia in association with prostatic carcinoma was documented on prostatectomy, performed 15 and 8weeks after the biopsy, respectively. Both patients experienced urinary infections during the interval between the biopsy and the prostatectomy. The third and fourth patient had a long-standing history of “prostatitis”, and acute urinary tract infection with urinary retention, respectively. The needle biopsy in both patients showed concomitant malakoplakia and prostatic carcinoma. One of them also had malakoplakia on the initial biopsy containing only atypical glands and on the subsequent one demonstrating carcinoma. One patient was treated conservatively and one with prostatectomy. Although coexistent prostatic carcinoma and malakoplakia are exceedingly rare, malakoplakia can likely occur as an exceptionally rare complication of a prostate needle biopsy, particularly in individuals with long-term or acute urinary tract infections at the time of the biopsy.


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Dr. Nawaid Usmani and team receive funding for their PRIME study!

The PRIME Study – Prevention and Intervention for MEtabolic syndrome:

Androgen deprivation therapy (ADT), and newer manipulations of androgen receptor signaling have improved outcomes for advanced prostate cancer (PCa) patients.  The toxicities of ADT are many, including an increased risk of developing metabolic syndrome (MS; defined as at least 3 of: hyperglycemia; abdominal obesity; hypertriglyceridemia; reduced HDL cholesterol; and/or hypertension). MS is associated with an increased risk of diabetes, cardiovascular disease mortality, stroke mortality, and all-cause mortality.  The prevalence of MS in men receiving ADT is at least 50% and contributes to decreased quality of life and increased non-cancer-related mortality.  Metformin holds promise as a countermeasure to MS development, and also has been shown to suppress PCa growth in pre-clinical models.

We hypothesize that the addition of metformin to ADT will reduce the rates of MS in men with advanced PCa, diminishing important toxicities of a therapy universally used in advanced disease.

We propose a double-blind, randomized phase III study of metformin or placebo in men with PCa starting intermittent ADT. The primary endpoint is the difference in MS rates at 1 year.  Other aims include evaluation of the influence of metformin on: individual MS components at additional time points; mean serum insulin levels and measures of insulin resistance; weight and quality of life.

A finding that metformin reduces MS incidence and/or has other benefits would change practice, as it would provide a practical and inexpensive strategy to reduce toxicity of an intervention employed in most men with advanced PCa.

- Catalina Vasquez