Abstract
OBJECTIVES: This study aimed to evaluate the diagnostic utility of GATA3 and CD138 as basal compartment markers in differentiating benign prostatic hyperplasia (BPH) from prostate cancer (PCa). METHODS: Immunohistochemical analysis of GATA3, CD138, CK34βE12, and P63 was performed on 131 prostate tissue samples (77BPH,54PCa). Expression profiles, sensitivity, specificity, and Cohen's Kappa agreement were compared between markers. RESULTS: In BPH samples, nuclear expression of GATA3 and p63 showed identical positive rates (92.21%, 95%CI: 89.3-94.8%), while CD138 (antibody concentration 1:200) and CK34βE12 (antibody concentration 1:100) demonstrated cytoplasmic/membranous positivity in 96.10% (93.4-98.1%) and 93.51% (90.2-95.9%) of cases respectively. All markers exhibited complete negativity (H-score < 5) in PCa basal cells.GATA3 achieved 100% diagnostic concordance (95%CI: 97.8-100%) with p63 in both BPH and PCa (perfect agreement, κ = 1, p < 0.001 by McNemar-Bowker test). Compared to CK34βE12:In BPH: Sensitivity = 98.61% (97.2-99.4%), Specificity = 100% (NPV 96.3%);In PCa: Diagnostic accuracy = 100% (AUC 1.0);(Inter-rater reliability κ = 0.902-1.0, weighted least squares method).CD138 achieved 100% analytic sensitivity but suboptimal specificity (57.1%, 95%CI: 44.8-68.7%) in BPH when referenced against p63/CK34βE12, while achieving perfect discrimination (κ = 0.926, p = 7.6 × 10(- 12)) in PCa cohorts. CONCLUSIONS: GATA3 and CD138 demonstrate basal compartment enrichment patterns that complement conventional markers for PCa diagnosis (accuracy 96-100%). Their nuclear (GATA3) and cytoplasmic (CD138) localization enhances reliability, particularly in cases with fixation artifacts or ambiguous morphology.