Abstract
There has been a rapid increase in the incidence of prostate cancer in China, especially in areas with boosted economic development. In this study, we analyzed the pathological features of a contemporary series of radical prostatectomy cases. A total of 230 consecutive, whole-mounted radical prostatectomy specimens collected from 2012 to 2014 were reviewed. The median age of the patients was 68 years, and 64.3% of patients presented with prostate specific antigen alone. Pathological examination indicated that a high proportion (77.4%) of patients had intermediate- or high-risk disease according to the Cancer of the Prostate Risk Assessment Post-Surgical score. After surgery, only 28 patients met the criteria for active surveillance (organ-confined Gleason ≥6 disease). The Prostate Cancer Research International Active Surveillance criteria achieved a sensitivity of 57.1% and a specificity of 98.0% for identifying candidates. The probability of Gleason score upgrading was 24.8% in the entire group and 59.0% in biopsy-confirmed Gleason ≥6 disease. The predominant tumor was located in the transition zone in 14.8% of cases, while only three patients (1.3%) had a predominant tumor located in the anterior region. Patients with transition zone-predominant tumor were likely to have been referred with urinary symptoms and high prostate specific antigen levels. The results of this study highlight the contemporary pathological features of localized prostate cancer in urban China. There was an increased trend towards asymptomatic cases, though most patients had intermediate- or high-risk disease and were suitable for definitive treatment. The low prevalence of dominant cancer in the anterior region may reflect race-based pathological differences.
Highlights
Prostate cancer (PCa) was regarded as a rare disease in China as recently as a decade ago, with a reported incidence of 1.6 per 10,000 [1]
This study showed that a significant proportion of Chinese PCa patients were diagnosed with increasing prostate specific antigen (PSA), without symptoms
This situation differs from that seen a decade ago, when Peyromaure et al reported that only 6.2% of Chinese patients had asymptomatic PCa [4]
Summary
Prostate cancer (PCa) was regarded as a rare disease in China as recently as a decade ago, with a reported incidence of 1.6 per 10,000 [1]. The cancer registry in urban Shanghai from 2000 to 2009 showed that 86% of patients had nonmetastatic disease at diagnosis, and RP was performed in 43% of subjects [5]. These changes in disease pattern indicate the need for further research on localized disease. We considered the following issues in the context of Chinese subjects: the current pathological characteristics and risk profile of localized disease; the feasibility and performance of active surveillance criteria; and tumor distribution and its possible implications for diagnosis and treatment
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