Abstract
With the introduction of magnetic resonance imaging in the diagnosis of prostate cancer and its use in targeted prostate biopsy, an increased incidence of anterior-predominant prostate cancer (APC) has been observed. We enrolled 200 patients who underwent radical prostatectomy at our department between 12/2017 and 04/2019. We evaluated tumour location in the individual segments of the prostate, index tumour location and volume, and compared the postoperative stage, Gleason score, grade group (GG), and the presence of extraprostatic extension (EPE) in APC and posterior prostate cancer (PPC). We assessed the rate of MRI scans prior to prostate surgery as well as the influence of family history and PSA on the presence of APC. We found a significantly higher rate of anterior tumours than previously reported (37%) and confirmed that these tumours are diagnosed with a significantly larger index tumour volume (P=0.003). We also showed that a mere 6.76% of APCs were low-risk tumours not requiring radical treatment. Furthermore, anterior tumours were found significantly more often (P=0.001) in patients who underwent preoperative MRI. No differences were observed between PSA values, family history, presence of EPE, or locally advanced disease in APC vs. PPC. The frequency of anterior tumours is higher than previously thought, and they include tumours requiring radical treatment. When these tumours are neglected, it may lead to patient undertreatment with impact on their life prognosis. Thus, we consider the use of MRI-targeted prostate biopsy to be a necessity both for ruling out APC in the case of repeatedly negative prostate biopsies and, in particular, before patient inclusion in active surveillance.
Highlights
The predominant location of prostate cancer in the peripheral zone (PPC – posterior prostate cancer) is well known
Anterior prostate cancer (APC) is defined as a tumour located above the urethra and it contains periurethral tissues, anterior horns of the peripheral zone (APZ), transition zone (TZ), and anterior fibromuscular stroma (AFMS) (Fig. 1)
Since the introduction of new imaging techniques and the use of targeted biopsy even in the transition zone and anterior fibromuscular area (TZ and AFMS), the number of patients diagnosed with a tumour with a predilection in the anterior zone has been increasing
Summary
The predominant location of prostate cancer in the peripheral zone (PPC – posterior prostate cancer) is well known. Anterior prostate cancer (APC) is defined as a tumour located above the urethra and it contains periurethral tissues, anterior horns of the peripheral zone (APZ), transition zone (TZ), and anterior fibromuscular stroma (AFMS) (Fig. 1). Since the introduction of new imaging techniques and the use of targeted biopsy even in the transition zone and anterior fibromuscular area (TZ and AFMS), the number of patients diagnosed with a tumour with a predilection in the anterior zone has been increasing. This results in an increasing number of these tumours in radical prostatectomy specimens. Data on tumour location in the individual segments of the prostate obtained from radical prostatectomies are necessarily influenced by this fact
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