DOI QR코드

DOI QR Code

Overview of Benign and Malignant Prostatic Disease in Pakistani Patients: A Clinical and Histopathological Perspective

  • Arshad, Huma (Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital) ;
  • Ahmad, Zubair (Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital)
  • Published : 2013.05.30

Abstract

Background: To present the overall clinical and histological perspective of benign and malignant prostatic disease as seen in our practice in the Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods: All consecutive prostate specimens (transurethral resection or TUR, enucleation, needle biopsies) received between July 1, 2012 and December 31, 2012 were included in the study. Results: Of the total of 785 cases, 621 (79.1%) were TUR specimens, 80 (10.2%) enucleation specimens, and 84 (10.7%) needle biopsies. Some 595 (75.8%) were benign, while 190 (24.2%) were malignant. Mean weight of BPH specimens was 19 grams and 43 grams for TUR and enucleation specimens respectively. Almost 67% of adenocarcinomas were detected on TUR or enucleation specimens. Of the above cases, 41.7% were clinically benign while 58.3% were clinically malignant. The average volume of carcinoma in all cases ranged between 60 to 65%. The average number of cores involved in needle biopsies was 5. In general, higher Gleason scores were seen in TUR/enucleation specimens than in needle biopsies. Overall, in all types of specimens, commonest Gleason score was 7, seen in 74 (38.9%) cases, followed by Gleason score 9 seen in 47 (24.7%) cases. Out of the 63 needle biopsies with carcinoma, radical prostatectomy was performed in 16 cases (25.4%). Conclusions: Benign prostatic hyperplasia (BPH) is extremely common and constitutes the bulk of prostate specimens. TMajority of prostatic carcinomas are still diagnosed on TUR or enucleation specimens. These included both clinically benign and clinically malignant cases. The volume of carcinoma in these specimens was quite high indicating extensive disease. Gleason scores were also generally high compared with scores from needle biopsies. Commonest Gleason score in all type of specimens was 7. Pathologic staging was possible in very few cases since radical prostatectomies are rarely performed.

Keywords

Benign prostatic hyperplasia;prostatic carcinoma;TUR;enucleation;needle biopsy;Pakistan

References

  1. Dong F, Wang C, Farris AB, et al (2012). Impact on the clinical outcome of prostate cancer by the 2005 international society of urological pathology modified Gleason grading system. Am J Surg Pathol, 36, 838-43. https://doi.org/10.1097/PAS.0b013e3182486faf
  2. Eble JN, Epstein JI (1990). Stage A carcinoma of the prostate. In Roth LM, ed. Pathology of the Prostate, Seminal Vesicles and Male Urethra. New York: Churchill Livingstone, 1990; 61-82
  3. Epstein JI (2010). An update of the gleason grading system. J Urol, 183, 433-40. https://doi.org/10.1016/j.juro.2009.10.046
  4. Epstein JI, Netto GJ (2010). Urinary Tract and Male Genital System. The Prostate and Seminal Vesicles. In Mills SE ed. Sternberg's Diagnostic Surgical Pathology, Fifth Edition, Volume 2. Lippincott Williams and Wilkins, Baltimore, MD: 1870-913.
  5. Epstein JI, Srigley J, Grignon D, Humphrey P (2007). Association of directors of anatomic and surgical pathology. Recommendations for the reporting of prostate carcinoma. Hum Pathol, 38, 1305-9. https://doi.org/10.1016/j.humpath.2007.05.015
  6. Epstein JI, Partin AW, Sauvageot J, Walsh PC (1996). Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol, 20, 286-92. https://doi.org/10.1097/00000478-199603000-00004
  7. Freedland SJ, Aronson WJ, Terris MK, et al (2003). Percent of prostate needle biopsy cores with cancer is a significant independent predictor of prostate specific antigen recurrence following radical prostatectomy: results from SEARCH database. J Urol, 169, 2136-41. https://doi.org/10.1097/01.ju.0000065588.82511.06
  8. Freedland SJ, Csathy GS, Dorey F, Aronson WJ (2002). Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score. J Urol, 167, 516-20. https://doi.org/10.1016/S0022-5347(01)69076-1
  9. Forman JD, Order SE, Zinreich ES, et al (1986). The correlation of pretreatment transurethral resection of prostatic cancer with tumor dissemination and disease-free survival. A univariate and multivariate analysis. Cancer, 58, 1770-8. https://doi.org/10.1002/1097-0142(19861015)58:8<1770::AID-CNCR2820580832>3.0.CO;2-U
  10. Green IF, Bleach AD, Anchala PR, et al (2012). Trends in prostatic adenocarcinoma tumor volume by visual estimation in prostatectomy specimens. Pathol Res Pract, 208, 578-83 https://doi.org/10.1016/j.prp.2012.06.006
  11. Green GA, Hanlon AL, Al-Saleem T, Hanks GE (1998) A Gleason score of 7 predicts a worse outcome for prostate carcinoma patients treated with radiotherapy. Cancer, 83, 971-6. https://doi.org/10.1002/(SICI)1097-0142(19980901)83:5<971::AID-CNCR24>3.0.CO;2-R
  12. Guarneri A, Botticella A, Filippi AR, et al (2013). 125I brachytherapy for localized prostate cancer: a single institution experience. Tumori, 99, 83-7.
  13. Kryvenko ON, Diaz M, Meier FA, et al (2012). Findings in 12-core transrectal ultrasound-guided prostate needle biopsy that predict more advanced cancer at prostatectomy: analysis of 388 biopsy-prostatectomy pairs. Am J Clin Pathol, 137, 739-46. https://doi.org/10.1309/AJCPWIZ9X2DMBEBM
  14. Kuo YJ, Lin SF, Chang YH, Fay CC (2012). Trends in prostate needle biopsy diagnosis. A ten year experience of a medical center in Taiwan. Pathol Int, 62, 191-8. https://doi.org/10.1111/j.1440-1827.2012.02794.x
  15. Ahmad Z, Arshad H (2012). Needle biopsy findings in prostatic adenocarcinoma: experience at a tertiary care center in a developing country. Ann Diagn Pathol, 17, 235-8.
  16. Ahmad Z, Najamul SA, Fouzia R, et al (2007a). Frequency Of Primary Solid Malignant Neoplasms In Different Age Groups As Seen In Our Practice. J Ayub Med Coll Abbottabad, 19, 56-63.
  17. Ahmad Z, Najamul SA, Nausheen Y, et al (2007b). Frequency of Primary Solid Malignant Neoplasms in Both Sexes, as seen in our Practice. J Ayub Med Coll Abbottabad, 19, 53-5.
  18. Billis A, Guimaraes MS, Freitas LL, et al (2008). The impact of the 2005 international society of urological pathology consensus conference on standard Gleason grading of prostatic carcinoma in needle biopsies. J Urol, 180, 548-52. https://doi.org/10.1016/j.juro.2008.04.018
  19. Corn PG, Song DY, Heath E, et al (2013). Sunitinib plus androgen deprivation and radiation therapy for patients with localized high-risk prostate cancer: results from a multi-institutional phase 1 study. Int J Radiat Oncol Biol Phys, 86, 540-5. https://doi.org/10.1016/j.ijrobp.2012.12.029
  20. Christensen WN, Partin AW, Walsh PC, Epstein JI (1990). Pathologic findings in clinical stage A2 prostate cancer. Relation of tumor volume, grade, and location to pathologic stage. Cancer, 65, 1021-7. https://doi.org/10.1002/1097-0142(19900215)65:4<1021::AID-CNCR2820650430>3.0.CO;2-L
  21. Larsen MP, Carter HB, Epstein JI (1991). Can stage A1 tumor extent be predicted by transurethral resection tumor volume, per cent or grade? A study of 64 stage A1 radical prostatectomies with comparison to prostates removed for stages A2 and B disease. J Urol, 146, 1059-63.
  22. Lilleby W, Torlakovic G, Torlakovic E, et al (2001). Prognostic significance of histologic grading in patients with prostate carcinoma who are assessed by the Gleason and World Health Organization grading systems in needle biopsies obtained prior to radiotherapy. Cancer, 92, 311-9. https://doi.org/10.1002/1097-0142(20010715)92:2<311::AID-CNCR1324>3.0.CO;2-H
  23. McDowell PR, Fox WM, Epstein JI (1994). Is submission of remaining tissue necessary when incidental carcinoma of the prostate is found on transurethral resection? Hum Pathol, 25, 493-7. https://doi.org/10.1016/0046-8177(94)90121-X
  24. Memon A, Ahmad Z, Qureshi A, et al (2009). Staging of prostate adenocarcinoma with radical prostatectomy specimens in Pakistan. Asian Pac J Cancer Prev, 10, 551-4.
  25. Murphy WM, Dean PJ, Brasfield JA, Tatum L (1986). Incidental carcinoma of the prostate. How much sampling is adequate? Am J Surg Pathol, 10, 170-4 https://doi.org/10.1097/00000478-198603000-00003
  26. Newman AJ Jr, Graham MA, Carlton CE Jr, Lieman S (1982). Incidental carcinoma of the prostate at the time of transurethral resection: importance of evaluating every chip. J Urol, 128, 948-50.
  27. Roos NP, Wennberg JE, Malenka DJ, et al (1989). Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med, 320, 1120-4. https://doi.org/10.1056/NEJM198904273201705
  28. Male reproductive system. The prostate and seminal vesicles. In Rosai J ed: Rosai and Ackerman,s Surgical Pathology, Tenth Edition 2011, Elsevier Inc, 1287-1333.
  29. Rubin MA, Bismar TA, Curtis S, Montie JE (2004). Prostate needle biopsy reporting: how are the surgical members of the society of Urologic Oncology using pathology reports to guide treatment of prostate cancer patients? Am J Surg Pathol, 28, 946-52 https://doi.org/10.1097/00000478-200407000-00016
  30. Sapira MK, Obiorah CC (2012). Age and pathology of prostate cancer in South-Southern Nigeria; is there a pattern? Med J Malaysia, 67, 417-9.
  31. Sebo TJ, Bock BJ, Cheville JC, et al (2000). The percent of cores positives for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy. J Urol, 163, 174-8 https://doi.org/10.1016/S0022-5347(05)67998-0
  32. Shah RB (2009). Current perspectives on the gleason grading of prostate cancer. Arch Pathol Lab Med, 133, 1810-6
  33. Schmid HP, McNeal JE (1992). An abbreviated standard procedure for accurate tumor volume estimation in prostate cancer. Am J Surg Pathol, 16, 184-91. https://doi.org/10.1097/00000478-199202000-00012
  34. Vollmer RT (2009). Percentage of tumor in prostatectomy specimens: a study of American Veterans. Am J Clin Pathol, 131, 86-91. https://doi.org/10.1309/AJCPX5MAMNMFE6FQ
  35. Vollmer RT (1986). Prostate cancer and chip specimens: complete versus partial sampling. Hum Pathol, 17, 285-90. https://doi.org/10.1016/S0046-8177(83)80221-4
  36. Wang X, Guo Z, Wang HT, Si TG (2012). Clinical features and prognostic analysis in prostate cancer patients under 59 years of age: a report of 72 cases. Zhonghua Yi Xue Za Zhi, 92, 1300-3.
  37. Zincke H, Bergstralh EJ, Blute ML, et al (1994). Radical prostatectomy for clinically localized prostate cancer. Long term results of 1143 patients from a single institution. J Clin Oncol, 12, 2254-63.

Cited by

  1. Histopathologic Characterization of Prostate Diseases in Madinah, Saudi Arabia vol.15, pp.10, 2014, https://doi.org/10.7314/APJCP.2014.15.10.4175
  2. Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity vol.15, pp.20, 2014, https://doi.org/10.7314/APJCP.2014.15.20.8937
  3. How Our Practice of Histopathology, Especially Tumour Pathology has Changed in the Last Two Decades: Reflections from a Major Referral Center in Pakistan vol.15, pp.9, 2014, https://doi.org/10.7314/APJCP.2014.15.9.3829
  4. Prostate Cancer in Iran: Trends in Incidence and Morphological and Epidemiological Characteristics vol.17, pp.2, 2016, https://doi.org/10.7314/APJCP.2016.17.2.839