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Test Name:Prostate cocktail by IHC
Test Number:12376 - Technical only; 12379 - Technical & Interpretation
Collect:Formalin-fixed, paraffin embedded (FFPE) tissue block
Container:FFPE tissue block
Processing:Submit processed tissue block or tissue section mounted on a charged, unstained slide
Transport/Stability:Ambient (preferred)
Alternate Names:P504S/AMCR
P63
IHC
LAB12376
LAB12379
Performing Lab:AHL - Immunohistochemistry
Days Set Up:Mo - Fr
Expected TAT:1 - 2 days
Ref. Ranges:If requested, an interpretive report will be provided
All IHC stains will include a positive control tissue
Collection/
Processing Details:

Antibody:

Cocktail composed of antibodies to P504S/ Alpha-methlylacyl-CoA Racemase (AMACR) and P63

Specifications:
  • Prostate cocktail contains both P504S and P63 to simultaneously evaluate for potentially malignant prostate glands and the outer basal cell layer of glands
  • P504S is a prostate cancer specific gene found in prostatic adenocarcinomas (82-100% of cases) and high-grade PIN (64%)
  • P504S is usually not present (or is focal and weak) in benign prostatic tissues
  • P63 is a marker of myoepithelial cells (which should be present in benign glands and in high grade PIN)

Staining pattern:

Dual stain, with red and brown chromogens showing:
  • Red: Strong granular cytoplasmic and apical staining for P504S, with circumferential staining of malignant glands
  • Brown: nuclear staining for P63 in myoepithelial cells
Applications:
  • Prostate cocktail can be used to discriminate prostatic adenocarcinoma from high-grade PIN, and from benign glands
  • Important exceptions: in our lab, P504S does stain seminal vesicles and ejaculatory ducts. Therefore, it is important to evaluate for pigment (which would be consistent with either ejaculatory ducts or seminal vesicles) before interpreting the P504S
  • P504S is not specific for prostate, and therefore should only be used on prostate tissues. Other tissues that can stain for P504S include
Prostate cancer vs HGPIN
p504S (racemase) p63
Cancer + -
HGPIN + +
Benign - -
References:
  1. Jiang Z et al: P504S; a new molecular marker for the detection of prostate carcinoma. Am J Surg Pathol 25(11): 1397-1404, 2001.
  2. Yang XJ et al: Expression of alpha-methylacyl-CoA racemase (P504S) in atypical adenomatous hyperplasia of the prostate. Am J Surg Pathol 26(7); 921-925, 2002.
  3. Zhou M et al: Alpha-methlylacyl-CoA racemase; a novel tumor marker over-expressed in several human cancers and their precursor lesions. Am J Surg Pathol 26(7); 926-931, 2002.
  4. Jiang Z et al: P504S/alpha-methylacyl-coA racemase; a useful marker for diagnosis of small foci of prostatic carcinoma on needle biopsy. Am J Surg Pathol (26(9): 1169-1174,2002.
  5. Beach R et al: P504S immunohistochemical detection in 405 prostatic specimens including 376 18-gauge needle biopsies. Am J Surg Pathol 26(12):1588- 1596, 2002.
  6. Jiang Z et al Discovery and Clinical Application of a Novel Prostate Cancer Marker (P504S). Am J Clin Pathol 2004 122: 275-289.
Method:Immunohistochemical staining
Microscopic examination
CPT Codes:88342 - 1st stain
88341 - each additional stain
Date Created:10/31/2017
Revised Date:10/19/2018