Quantitative tissue analyses of prostate cancer foci in an unselected cystoprostatectomy series - Abstract

OBJECTIVE: To describe multifocality, volume and location of prostate cancers incidentally found in cystoprostatectomy specimens. Quantitative tissue analysis of prostate cancer in a population free of the evaluation bias associated with prostate-specific antigen level and biopsy is important as some men are likely to be offered tissue-preserving therapeutic strategies in the future.

PATIENTS AND METHODS: Cystoprostatectomy specimens for bladder cancer from 345 consecutive patients without clinically manifest prostate cancer were included. Cancers were found in 104/345 (30%) of prostates. Cases with largest cancer >2 mL (eight patients) were excluded from morphometric study. Quantitative tissue analysis of 3-mm step-sectioned glands included largest cancer surface area, volume, site of origin, multifocality and laterality.

RESULTS: In the 96 prostates, 215 cancer foci were identified (mean 2.24). Prostate cancer was multifocal in 58% and bilateral in 79% of cases. Of the 215 cancers, 90% were < 0.5 mL and 79% < 0.2 mL. Overall, 88% of cancer foci were clinically insignificant with a volume of < 0.5 mL and no grades 4-5.  In all, 75% of the cancer foci were in the peripheral zone, the remainder were within the transition zone. One third of cancer foci were anteriorly located beyond the area sampled by posterior biopsies. One fifth of cancer foci were ≤6 mm of the apex.  Limitations include the fact that cystoprostatectomy cancer foci are at an earlier stage than screened-detected cancers.

CONCLUSION: This detailed morphometric analysis of prostate cancer foci in a population that is free from the selection bias associated with screening can help inform our diagnostic and treatment strategies.

Written by:
Nevoux P, Ouzzane A, Ahmed HU, Emberton M, Montironi R, Presti Jr JC, Villers A.   Are you the author?
Department of Urology, CHU Lille, Univ Lille Nord de France, Lille, France; Division of Surgery and Interventional Science, University College London, London, UK; Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy; Department of Urology, Stanford University Medical Center, CA, USA.

Reference: BJU Int. 2011 Dec 22. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10776.x

PubMed Abstract
PMID: 22192756

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