EAU 2019: Tumor Locations in the Prostate Gland Affect the Incidence, Clinicopathological Features and Prognosis of Prostate Cancer

Barcelona, Spain (UroToday.com) In this presentation, the authors attempted to answer the question of whether tumor location in the prostate gland affects the incidence, clinicopathological features, and prognosis of prostate cancer.

This was a retrospective study between 2000 and 2017 and included 916 patients who underwent radical prostatectomy with no neoadjuvant therapy in a single center. Serial whole mount sections were reviewed to determine the incidence, clinicopathologic features and prognostic significance of the tumor location in the prostate gland. The authors defined the prostate subzones for the purpose of noting the tumor location, based on subdivisions of McNeal’s zonal anatomy, as can be seen in figure 1. The clinicopathological features were evaluated according to the European Association of Urology (EAU) risk group. A PSA failure-free survival in each subzone was shown by Kaplan-Meier analysis using the Log-rank test. Lastly, multivariable analysis for PSA free survival was done using the Cox proportional hazards models. The patient characteristics are shown in table 1.
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Table 1 – Patient characteristics:

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The median follow-up time was 67 months, and the 5-year PSA recurrence rate in all cases was 23.2%. The PSA failure-free survival is shown in figure 2.

Figure 2 – PSA failure-free survival:

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The subzonal tumor incidence was the highest in subzonal area A2 with a value of 70%. The tumor incidence in the other prostate subzones is demonstrated in table 2. Prostate cancer was most frequently demonstrated in the posterolateral to anterolateral peripheral zone, followed by the anterior apex and anterior transitional zone. The lowest incidence was demonstrated in the posterior midline of the mid to base. The highest correlation with the EAU risk was seen in subzone M6, followed by B3, T3, and B2.

Table 2- Subzonal incidence of prostate cancer:

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Figure 3 demonstrates the % five-year PSA failures in each subzone of the prostate. The highest five-year PSA recurrence rate was seen in B3 (69.5%) followed by 49.3% in M6, 43% in B2, 41% in T4, and 34% in A3. Multivariable analysis demonstrated that B3 subzone had the highest risk for PSA recurrence, followed by B2, T4, B1, A3 (in that order).

Figure 3 – Tumor location and %5-year PSA failure:

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The authors concluded that the incidence and prognosis vary according to the tumor location within the prostate. The highest correlation with the EAU risk was seen in the M6 subzone, followed by B3, T3, and B2. Lastly, the B3 subzone around the ejaculatory duct showed the lowest tumor incidence, but the highest recurrence risk.


Presented by: Jun Akatsuka, MD, Nippon Medical School Hospital, Department of Urology, Tokyo, Japan  

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.