CHAPTER I INTRODUCTION 1.1 Background High-grade Prostatic Intraepithelial Neoplasm (HGPIN) is a pre cancerous lesions in prostate malignancy.

Several recent studies have found that HGPIN of biopsy findings indicating prostate cancer have a lesion in an area related to the prostate. This is still a controversial and needs to be proved. Presence or absence of basal cells in prostate tissue factor distinguishing between benign and malignant lesions. Immunohistochemistry examination of 903 is considered Sitokeratin specific examination for prostate cancer. In this examination gift HGPIN positive results, whereas the negative is prostate cancer. Theoretically, these tests can prove the hypothesis that HGPIN on biopsy findings indicating prostate cancer have a lesion on a place in the prostate. Therefore, comparison of results of immunohistochemistry on tissue Sitokeratin 903 biopsy results (with the results of HGPIN and prostate adenomakarsinoma) and tissue from TURP need to be investigated. 1.2 Formulation problem
Whether the findings HGPIN and prostate adenocarcinoma with sitokeratin 903 on prostate biopsy showed a loss of basal cells are prostate cells?

1.4 Hypothesis Findings HGPIN and prostate adenomakarsinoma with sitokeratin 903 on prostate biopsy showed the loss of prostatic basal cells

1.3 Purpose General purpose Knowing the meaning of the findings HGPIN and prostatic adenocarcinoma on prostate biopsy Special purpose To compare changes in basal cell sitokeratin which 903 occurred in HGPIN and prostate adenocarcinoma.
1.5 Benefits

For Academic or Scientific field :

1. Know the role of the basal cell staining for diagnosing sitokeratin 903 in

HGPIN and prostate adenocarcinoma

Researcher :
1. Fulfilled the academic requirements of the researchers in order to

complete the education specialist urology.

2. Increased technical capacity to develop good research proposal. 3. Increased ability to think in order to construct a scientific research valid

medical, ethical, and helpful.

4. Increased communication skills between researchers with fellow

researchers, practitioners, research subjects, and the relevant parties.

5. Formation of new hypotheses as a basis for further research.

CHAPTER II LITERATURE REVIEW 2.1 Literature Study Prostate cancer is the most visceral cancers often occur in men and one of the main causes of death, but the diagnostic and prognostic criteria defined yet. Prostate cancer diagnosis based on the evaluation of histological and cytological changes, and at this time to obtain significant results, Immunohistochemical analysis began linked to help enforce prostat1 cancer. On histology, found changes in the structure described by an irregular arrangement of pseudoglandular formation, whereas cytology was found in the enlarged cells and nuclei with large nucleoli, eccentric, and multiple1,2. The disappearance of the basal cell layer of prostate acini is one important characteristic of prostat1 adenocarcinoma, which was found through a microscope. This is the first time proposed by Lewis in 1950 and in 1953 used as diagnostic criteria by Toten3. Demand quick examination to detect prostate cancer has increased, because it allows for better results from the disease. The absence of basal cells in the prostate is asini essential characteristics in the diagnosis of prostate cancer. Prostatic intraepithelial neoplasia (PIN) architecture consists of benign prostatic acini or duct cells limited by cytologically atypical cells and classified into low-grade and high-grade4. Prostatic intraepithelial neoplasia (PIN) is a process involving the prostate ducts and acini which had dysplasia. Often looked multisentrik and may spread to the utricle prostat5. Some studies indicate a statistical relationship between HGPIN and prostate tumors, where the PIN is found in 50%-100% of the specimens radical prostatektomi5. And also seems that the prostate that contains the PIN and adenocarcinoma, there is a good match level on the second form of DNA diploid lesions. This discovery gave birth to the notion that the PIN can provide a high predictive value for malignancy signs (tumor)5. The largest studies reporting 16% to 44.6% risk of cancer on subsequent biopsy. Of 11 studies with at least 50 cases of
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HGPIN on needle biopsy with further action, the average risk of cancer was 26.4% (Epstein, 2006)4.

Figure 1. Changes from normal prostate cells become malignant

Keratin or sitokeratin a water-insoluble, which are fibers of intracellular proteins in almost all epithelium. Sitokeratin a group of proteins intermediate filaments (intermediate filament protein) which is a pair of non-keratinized and keratinized epitel7 network. Sitokeratin has an important role in the differentiation and function to maintain the structural integrity of epithelial cells.Sitokeratin eventually serve as a specific marker for tissue differentiation can be used directly to indicate the existence of a malignancy7. Distribution of this sitokeratin can be mapped in the end by using monoclonal antibodies (sitokeratin 903)6.

CHAPTER III RESEARCH METHODOLOGY 3.1 Materials Research During the study period were collected 20 specimens of paraffin blocks, each of HGPIN (N = 10) and prostate adenocarcinoma (N = 10). Objects in this study were patients who showed clinical examination of BPH and anatomical pathology tests High Grade PIN and prostate adenocarcinoma patients treated in RSHS urology surgery department from January 2008 to October 2009. Inclusion criteria :
1. All BPH patients with PA of High Grade PIN and prostate

adenocarcinoma patients
2. Patients treated RSHS urology surgery departement from January 2008 to

October 2009

Exclusion criteria :
1. BPH patients with High Grade PIN and prostate adenomakarsinoma

paraffin blocks, but the dosage is too small (like yarn)

3.2 Research Methods Prostate biopsy specimens and TURP is a specimen taken from the same patient. All the specimens stained by immunohistochemistry with coloring of sitokeratin 903, and then read by a pathologist. Demographic data from medical record.

3.2.1 Research design An observational study with a cross cut design (cross sectional study). The sample in this study is the total sampling taken from all patients with the PA BPH High Grade PIN and prostate adenomakarsinoma patients treated at RSHS Urology Surgery department, period January 2008 until October 2009. 3.2.2 Identification Variables Independent variable : Immunohistochemical examination with sitokeratin 903. Dependent variable : HGPIN and adenokarsinoma prostat. 3.2.3 Works and data collection techniques Retrieving data from medical record of patients who in the diagnosis of BPH with High Grade PIN and prostate adenomakarsinoma. Then from the data, we search the block parafin, and re-done with immunohistochemistry staining sitokeratin 903. After that, the examinations performed with a microscope to find the basal cells, and calculated the percentage of basal cells found in the amount of preparation. 3.2.4 Place and time of research This research was conducted in department of Urology Surgery FKUP/RSHS Bandung. Research conducted during the period January 2008 to October 2009.

CHAPTER IV RESEARCH RESULTS AND DISCUSSION

4.1 Research Results

From the studied of 20 preparations, it was found that all preparations (100%) HGPIN is characterized by Histokimia coloring. 903 lose Sitokeratin basal cell layer of the same as happened in adenomakarsinoma prostate.
4.2 Discussion

In this study, all patients with High Grade PIN and prostate adenocarcinoma patients initially performed with HE staining for the early diagnosis. Then from the same preparations made Immunohistochemistry staining sitokeratin 903. It turned out that the preparation obtained in High Grade PIN basal cells of the same loss as in prostate adenocarcinoma, which means the image shows the process of malignancy. Thus examination by Imunophistokimia Sitokeratin 903 can be one of the diagnostic options.

Figure 2. High Grade PIN I

Figure 3. High Grade PIN II

Figure 4. High Grade PIN IV

CHAPTER V CONCLUSIONS AND RECOMMENDATIONS 5.1 Conclusion From the results of this study can conclude that the method of examination sitokeratin 903 Immunohistochemistry may be a diagnostic option in BPH with a suspicion of malignancy. 5.2 Recommendations
1. To do further research using a larger sample. 2. Need to do research on the sensitivity and specificity of the method of

examination Immunohistochemistry sitokeratin 903 in BPH with suspicion of malignancy.

REFERENCES

1. Acimovic M, Govedararevic V, Mitrovic D, et al. Correlation of highmolecular cytokeratin in tissue of prostatic cancer with Gleason Score and PSA. Acta Chir Iugosl. 2005;52(4):45-9 2. Kirk JW, Epstein J. The utility of basal cell-spesific anti-cytokeratin antibody in diagnosis of prostate cancer. Am Jsurg Pathol 1995;19(3):251-60
3. Oliai BR, Kahane H, Epstein J. Can basal cells be seen in adenocarcinoma of

prostate. An immunohistochemical study using high molecular cytokeratin (clone 34E12) antibody. Am J Surg Pathol 2002;26(9):1151-60 4. Sigman M, Jonathan P. Male Infertility. Wein Aj, Partin AW, Peters CA. Editors. Campbell Walsh Urology 9th.2007. Philadephia : WB saunders. P2727-65
5. Ackerman, Rosai. Surgical Pathology 9th. Juan Rosai. Editors.2004.

London : Mosby. p37-56 6. Pulford, K.A,et al. The characterization of two monoclonal antikeratin antibodies and their use in study of epithelial disorders. Histopathology 9:825-840.

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