Amyloid deposits in prostate biopsy as an opportunity to diagnose early cardiac amyloidosis
María Cespón-Fernández
Edgar José Escalona-Canal
Jorge Sánchez-Ramos
Sergio Raposeiras-Roubín
Sámer Abdulkader-Sande
Rafael José Cobas-Paz
Cristina Torre-ira-Banzas
Emad Abu-Assi
Susana Teijeira-Bautista
Patricia Domínguez-Aristegui
Pablo García-Pavía
María Eugenia Escalona-Canal
Enrique Cespón-Outeda
José Ant-onio Ortiz-Rey
Abstract：Background The diagnostic delay of cardiac amyloidosis (CA) is known to be substantially long. A prolonged time from symptom onset to diagnosis negatively impacts the quality of life and life expectancy of the affected patients. We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.
Methods A systematic cardiological evaluation, comprising ECG, echocardiogram and 99mTc-DPD scintigraphy, was offered to a cohort of 19 patients with incidental prostatic amyloidosis (PA) findings, prospectively detected between 2014-2023, to assess cardiac involvement.
Results The median age of the patients was 80.2 years (IQR: 74.9-82.6 years). Histopathological study revealed amyloid deposits within the walls of small vessels (predominantly small arteries) in 18 patients and mainly in the stroma in the remaining case. All of them were immunohistochemically positive for transthyretin (ATTR) except one patient, with known myeloma, which was inconclusive for ATTR. Clonal dyscrasia was excluded in the rest of the patients. Thirteen patients (68.4%) underwent all cardiovascular tests, 4 patients (21.1%) underwent only ECG and echocardiographic evaluation and two patients (10.5%) refused to undergo any cardiological study. Among 13 individuals undergoing the complete evaluation, six patients were eventually diagnosed with CA (46.15%). All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.
Conclusion The finding of PA should prompt a complete cardiovascular examination, given the significant percentage of patients eventually diagnosed with early-stage CA. Multidisciplinary collaboration among different medical specialists must be encouraged, given the potential clinical impact of CA early diagnosis.
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Publication Date：2025-01-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：9( 169-177 )