Differentiating Benign and Malignant Prostatic Lesions using Mucin and DNA Histochemical Staining, Samples from Omdurman Teaching Hospital, Sudan

Abstract

Background: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the most common prostatic diseases in elderly men. Cost-effective methods are required to accurately differentiate benign hyperplasia from prostatic adenocarcinoma.

Methods: This is an analytical, cross-sectional study conducted on 109 archival paraffin-embedded prostate tissue samples obtained from Omdurman Teaching Hospital. Data collected included histopathological diagnosis, lesion type, patient age, and Gleason score for malignant cases. Three sections were prepared from each sample and stained using Periodic Acid–Schiff, Alcian blue (pH 2.5), and Feulgen reaction to assess mucin types and DNA intensity. The diagnostic value of these histochemical stains in differentiating benign and malignant prostatic lesions and their association with Gleason grading were evaluated.

Results: All 53 BPH cases showed positive staining for neutral mucins with complete absence of acidic mucins. In contrast, PCa samples demonstrated acidic mucin positivity in 22 cases (39.21%), neutral mucin positivity in 2 cases (3.5%), positivity for both mucin types in 17 cases (30.35%), and negativity for all mucins in 15 cases (26.78%). Statistically significant differences were observed between benign and malignant groups regarding mucin type and DNA staining intensity (p < 0.001). Additionally, Gleason score showed a significant association with both mucin type and DNA intensity in malignant cases (p < 0.001).

Conclusion: Mucin histochemical stain can be used as a useful biomarker in differentiating BPH from PCa. The intensity of DNA expression using Feulgen reaction may provide valuable prognostic information in prostate cancer.

Keywords: Prostate Adenocarcinoma, Benign Prostatic Hyperplasia, Mucin, DNA, Gleason score.