Some aspects of prostatic cytology

Abstract

Since the publication in 1943 of Papanicolau and Traut’s monograph on vaginal cytology, much attention has been focussed on the cells, both normal and neoplastic, exfoliating from almost every body surface.

From the diagnostic point of view the examination of material from the cervix and respiratory tract has been shown to be the most regularly rewarding.

Cytological studies may sometimes be valuable in peritoneal and pleural fluids and more recently washings from the alimentary tract have been used for the diagnosis of gastro-intestinal cancer.

There is no doubt concerning the value of urine examination for the demonstration of urinary tract disease. Search for inflammatory cells and casts and chemical investigation of urine in renal disease are carried out routinely. The detection of malignant cells in urine deposits in cases of suspected urinary tract cancer however is not attempted as a routine procedure in most laboratories at the present time. Conflicting evidence has been presented as to the value of this investigation. The value of prostatic smears following massage of the prostate gland has similarly been held in doubt as a useful method of detecting carcinoma of the prostate. Some workers have been enthusiastic in support of the technique, while others have considered that it is of little or no value. My interest in prostatic cytology was stimulated by this doubt particularly as it exists in regard to early or asymptomatic cases of prostatic cancer. However, before cytological diagnosis could be used routinely in the detection of prostatic carcinoma it was felt that familiarity with the normal cellular excretion of the prostate gland should be acquired and at the same time an attempt should be made to answer certain questions:

1. Could a useful number of positive diagnoses be given cytologically in early or even asymptomatic cases of prostatic carcinoma? Examination of the relevant literature showed disappointing results from North America in early diagnosis in this field. However, it was felt that even a small percentage of positive diagnoses might be useful, because no other laboratory technique offered help at this stage.

2. Would the presence of “latent” carcinoma of the prostate, as described by Franks (1954) and others, be a factor to be reckoned with in men in the age group at risk? – i.e. would “false positive” results be given in asymptomatic cases with “latent” carcinoma, in whom clinical symptoms would never arise?

3. Would the frequency of positive diagnoses given by this method in clinically probable cases of prostatic carcinoma be high enough to give useful corroborative evidence of malignancy?