Transurethral Resection Of The Prostate Specimens Research Articles

Isolated intraductal carcinoma of the prostate: a clinicopathological and molecular analysis

Objective: To study the clinicopathological features, immunohistochemical phenotypes, molecular changes, differential diagnosis and prognosis of isolated intraductal carcinoma of the prostate (iIDC-P). Methods: Three iIDC-P cases were collected retrospectively from 2016 to 2022 at Ningbo Clinical Pathology Diagnosis Center, Ningbo, China. The clinicopathologic features and immunophenotypic profiles were studied using light microscopy and immunohistochemistry. A targeted next-generation sequencing panel was used to analyze cancer-associated mutations. Follow-up and literature review were also performed. Results: The patients' ages were 61, 67 and 77 years, and their preoperative prostate specific antigen (PSA) levels were 7.99, 7.99 and 4.86 μg/L, respectively. Case 1 and 2 were diagnosed on needle biopsy and radical prostatectomy (RP) specimens, and case 3 was diagnosed on a specimen of transurethral resection of the prostate (TURP). The RP specimen was entirely submitted for histologic examination. In the case 1, iIDC-P was found in one tissue core (involving two ducts) in the biopsy specimen, and in 6 sections (diameter, 0.3-1.1 cm) from the radical prostatectomy specimen, and one section had separate foci of low-grade acinar adenocarcinoma (diameter, 0.05 cm). In the case 2, 6 tissue sections from the biopsy specimens showed iIDC-P, and 13 sections from RP specimen showed iIDC-P (diameter, 0.5-1.6 cm), and the other 3 sections had separate low grade acinar adenocarcinoma (diameter, 0.6 cm). In the case 3, 5 tissue blocks from the TURP specimen showed iIDC-P. The case 1 and 2 showed solid architecture with expansile proliferation of neoplastic cells in native ducts and acini. The case 3 showed dense or loose cribriform pattern, with marked cytological atypia, and frequent mitotic figures. Comedonecrosis was found in solid or dense cribriform glands in the case 2. Immunohistochemically, surrounding basal cells were highlighted using high-molecular-weight cytokeratin (34βE12 and CK5/6) and p63, while P504s was positive in the tumor cells. The tumor cells were also positive for AR and prostate markers (NKX3.1, PSA and PSAP), and negative for GATA3. The iIDC-P and acinar adenocarcinoma both showed weak PTEN expression and no ERG (nuclear) expression. In case 2 and 3, targeted sequencing revealed activated oncogenic driver mutations in MAPK and PI3K pathway genes (KRAS, MTOR and PTEN). In addition, pathogenic mutation in TP53 and FOXA1 mutation were found in the case 2 and 3, respectively. No case demonstrated TMPRSS2::ERG translocation. All cases were microsatellite stable and had lower tumor mutation burdens (range, 2.1-3.1 muts/Mb). The patients showed no biochemical recurrence or metastasis after follow-up of 16-91 months. Conclusions: iIDC-P is a special type of intraductal carcinoma of the prostate and differs from intraductal carcinoma within high-grade prostate cancer. iIDC-P has unique molecular characteristics and may represent as a molecularly unique in situ tumor of prostate cancer.

Develop prediction model to help forecast advanced prostate cancer patients' prognosis after surgery using neural network.

The effect of surgery on advanced prostate cancer (PC) is unclear and predictive model for postoperative survival is lacking yet. We investigate the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, to collect clinical features of advanced PC patients. According to clinical experience, age, race, grade, pathology, T, N, M, stage, size, regional nodes positive, regional nodes examined, surgery, radiotherapy, chemotherapy, history of malignancy, clinical Gleason score (composed of needle core biopsy or transurethral resection of the prostate specimens), pathological Gleason score (composed of prostatectomy specimens) and prostate-specific antigen (PSA) are the potential predictive variables. All samples are divided into train cohort (70% of total, for model training) and test cohort (30% of total, for model validation) by random sampling. We then develop neural network to predict advanced PC patients' overall. Area under receiver operating characteristic curve (AUC) is used to evaluate model's performance. 6380 patients, diagnosed with advanced (stage III-IV) prostate cancer and receiving surgery, have been included. The model using all collected clinical features as predictors and based on neural network algorithm performs best, which scores 0.7058 AUC (95% CIs, 0.7021-0.7068) in train cohort and 0.6925 AUC (95% CIs, 0.6906-0.6956) in test cohort. We then package it into a Windows 64-bit software. Patients with advanced prostate cancer may benefit from surgery. In order to forecast their overall survival, we first build a clinical features-based prognostic model. This model is accuracy and may offer some reference on clinical decision making.

Transfer Learning for Adenocarcinoma Classifications in the Transurethral Resection of Prostate Whole-Slide Images.

Simple SummaryIn this study, we trained deep learning models to classify TUR-P WSIs into prostate adenocarcinoma and benign (non-neoplastic) lesions using transfer and weakly supervised learning. Overall, the model achieved good classification performance in classifying whole-slide images, demonstrating the potential benefit of future deployments in a practical TUR-P histopathological diagnostic workflow system.The transurethral resection of the prostate (TUR-P) is an option for benign prostatic diseases, especially nodular hyperplasia patients who have moderate to severe urinary problems that have not responded to medication. Importantly, incidental prostate cancer is diagnosed at the time of TUR-P for benign prostatic disease. TUR-P specimens contain a large number of fragmented prostate tissues; this makes them time consuming to examine for pathologists as they have to check each fragment one by one. In this study, we trained deep learning models to classify TUR-P WSIs into prostate adenocarcinoma and benign (non-neoplastic) lesions using transfer and weakly supervised learning. We evaluated the models on TUR-P, needle biopsy, and The Cancer Genome Atlas (TCGA) public dataset test sets, achieving an ROC-AUC up to 0.984 in TUR-P test sets for adenocarcinoma. The results demonstrate the promising potential of deployment in a practical TUR-P histopathological diagnostic workflow system to improve the efficiency of pathologists.

Solitary fibrous tumors in prostate: a case report with review of the literature

Background Solitary fibrous tumor (SFT) is a relatively rare type of mesenchymal neoplasm that occurs most frequently in the pleura. However, SFT originating from the prostate is particularly uncommon and only approximately 39 cases were reported before. Herein, we reported a rare case of a patient diagnosed with prostate SFT and presented a literature review. Case presentation: A 50-year-old Asian with irritative urinary symptoms was admitted to our hospital and almost all the evidence indicated that benign prostate hyperplasia (BPH) caused his symptoms. Therefore, transurethral resection of the prostate (TURP) was performed, but histopathological and Immunohistochemical (IHC) assessments showed that spindle cells arranged disorderly in the TURP specimen with a cluster of differentiation 34 (CD34), B-cell lymphoma-2 (Bcl-2), and signal transducer and activator of transcription 6 (STAT6) highly expressed and SFT was diagnosed. Finally, the patient underwent a radical prostatectomy and there was no disease progression observed thereafter. Conclusions Prostate SFT is extremely rare, and to our knowledge, this is the first case of prostate SFT that is difficult to differentiate from small volume BPH. IHC examinations are of great diagnostic value. Radical resection of the tumor appears to be the most effective method at present and continuous follow-up is highly recommended.

T1a/T1b transitional zone prostate cancer detection rates in patients who had TURP for clinically diagnosed benign prostatic enlargement in Southern Nigeria

Background: Transurethral resection of the prostate (TURP) removes the obstructing adenoma that grows from the transitional zone of the prostate. Resected chips are routinely sent for histologic examination. Incidental findings of prostate cancer in the TURP specimen for the clinically diagnosed benign disease may occur. The American Joint Committee on Cancer (AJCC) TNM staging of prostate cancer allocates T1a if <5% of the resected chips are malignant and T1b if >5% are malignant.
 Aim: To determine the frequency of incidental prostate cancer rate in TURP specimens of patients who had the procedure for clinically diagnosed benign prostatic enlargement.
 Methodology: This was a retrospective study carried out over a period of 8years from January 2013 to December 2020 on patients who had TURP for clinically diagnosed BPE or biopsy diagnosed BPH. All the patients had TURP for benign enlargements of the prostate. The resected prostate chips were sent for histopathological analysis. Patients with incomplete data and patients who had transrectal peripheral zone prostate biopsy confirmed cancers before TURP were excluded from this study. The data was collated using Microsoft Excel version 2020 and was analyzed using SPSS version 20.
 Results: There were 220 male patients with a mean age was 65.89 ±9.95years, and median age was 65years. The 60-69years group had the highest incidence of PCa. The T1a/T1b adenocarcinoma detection rate was 13.6% (30). 54.6% (120) had BPH only, and 31.8% (70) had BPH with prostatitis. All incidentally diagnosed T1a/T1b cancers were adenocarcinomas. The majority of the T1a/T1b adenocarcinomas, 43.3% (13), were poorly differentiated, while 36.7% (11) and 20% (6) had well and moderate differentiation, respectively.
 Conclusion: The Incidental T1a/T1b transitional zone adenocarcinoma detection rate in TURP specimens in the study was 13.6%. The high Gleason’s grade adenocarcinoma was the most frequent. Even when perceived as clinically benign, communication of the risk of cancer detection to the patient is pertinent and should be a routine part of the informed consenting process before TURP.

Comparison laser anatomical endoscopic enucleation of the prostate (LAEEP) and transurethral resection of the prostate (TURP) in BPH treatment: A meta-analysis

and objectives: Laser anatomical endoscopic enucleation of the prostate (LAEEP) is one of the alternative surgical procedures other than TURP for benign prostate hyperplasia (BPH). However, the consideration for clinical practice needs evidence in terms of efficacy and safety. Our meta-analysis based on the existing studies is to evaluate the efficacy and safety of the LAEEP and TURP for BPH treatment. Published randomized controlled trials (RCTs) were identified from PubMed, Science Direct, and Cochrane Library up to December 2021. The meta-analysis was performed by the requirements of PRISMA and after methodological quality assessment, the data was proceeded by RevMan V.5.4. 15 studies were identified with total of 733 patients who underwent LAEEP and 698 patients underwent TURP. There was no significant difference in IPSS at 1,3,6 month but at 12 months significantly better in LAEEP (MD = −0.43 [-0.81, −0.05] P = 0.03). At 6 and 12 months, the PVR data showed significantly lower in LAEEP (MD = −4.07 [-6.07, −2.07] P < 0.0001). QoL, Qmax, and IIEF-5 scores were no significant difference in both procedures. Duration of catheterization (MD = −25.01 [-30.47, −19.55] P = 0.00001) and hospital stay (MD = −30.26 [-40.71, −19.82] P = 0,00001) were significantly shorter in LAEEP. Operative duration was significantly shorter in TURP (MD = 14.69 [8.64, 20.75] P = 0.00001) but prostate specimen weight result was significantly higher in LAEEP procedure (MD = 4.77 [0.36, 9.17] P = 0.03). Hb drop level (MD = −0.58 [-0.85, −0.30] P = 0.0001), transfusion rate (OR = 0.37 [0.17, 0.84] P = 0.02) and UTI (OR = 0.35 [0.17, 0.71] P = 0.004) were significantly fewer in LAEEP. However, dysuria events less occurred in TURP (OR = 2.45 [1.51, 3.97] P = 0.0003). Compared with TURP, LAEEP showed better efficacy and safety with fewer hematological changes and complications, except for operative duration, dysuria events were better in TURP. LAEEP showed other advantages in shorter catheterization time and hospital stay.

Incidence of incidental cancer in transurethral resection of prostate specimens: a 10-year retrospective analysis

BackgroundProstate cancer can be detected incidentally in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia. Therefore, it is very important that the transurethral resection of the prostate specimen is evaluated carefully for accurate grading and staging. The aim of this study was to investigate the frequency of incidental prostate cancer and its relationship with clinicopathological findings.MethodsThe study included a total of 900 patients, who underwent transurethral resection of the prostate for benign prostatic hyperplasia treatment between June 2010 and June 2020. Patient age, prostate-specific antigen (PSA) levels and resected prostate weight were assessed, and the tumor stage, Gleason grade group, lymphovascular and perineural invasion status were also evaluated in the incidental prostate cancer group. The association between these parameters and prostate cancer detection was analyzed.ResultsIncidental detection of prostate cancer was determined at the rate of 13.3%. The incidental prostate cancer group had a significantly higher mean age and PSA levels compared to the benign prostatic hyperplasia group. The weight of the resected specimen had no impact on the incidence of incidental prostate cancer. Of the total 120 incidental prostate cancer cases, 59 (49.2%) were stage T1a and 61 (50.8%) were stage T1b. No significant difference was determined between the T1 stages and age distribution, but a statistically significant difference was determined in the other clinicopathological parameters.ConclusionsThe results of this study demonstrated that the incidence of incidental prostate cancer detection was related to age and PSA levels and increased, especially in those aged ≥ 60 years and/or PSA level ≥ 4 ng/mL. To avoid overlooking incidental prostate cancer in these patients, it can be recommended that material is sufficiently sampled and carefully evaluated, and when necessary, all resected specimens are examined. Although no significant correlation was determined between specimen weight and the incidence of incidental prostate cancer, as a significant difference was determined in T1 stages, this suggests that the amount of material evaluated could change the sub-stage.

Histomorphological Mimickers of benign prostatic lesions with prostatic adenocarcinoma

Background: The prostate is a walnut-sized organ that surrounds the urethra. More than 99% of prostate cancers are prostatic adenocarcinoma. It is the second most commonly occurring cancer in men and the fourth most commonly occurring cancer in India and all over the world. Numerous lesion of the prostate are very similar to prostate cancer, hence awareness is very important. This study aimed to determine the histopathological features of prostate adenocarcinoma and its common mimickers.Materials and Methods: A retrospective study of histopathological features of radical prostatectomy and transurethral resection of the prostate specimens, sent to the department of pathology for a period of one year. A brief clinical history and serum prostate-specific antigen levels were noted.Results: The surgical specimens of 303 cases of prostatic diseases were studied. Benign prostatic hyperplasia was the most frequent diagnosis in 192 patients followed by Prostate adenocarcinoma seen in 80 patients. Prostatic intraepithelial neoplasia formed the predominant mimicker (5.9%), followed by basal cell hyperplasia (3.0%). Serum prostate-specific antigen was seen in the range of 1.73 - 100 ng/ml in the cases of adenocarcinoma. In the mimics, prostate-specific antigen was in the range of 1.2- 18ng/ml.Conclusions: Biopsy remains a gold standard for the diagnosis of adenocarcinoma and its mimickers. The lesions in this study were diagnosed on hematoxylin and eosin staining.

Оценка эффективности персонализированной комплексной терапии в профилактике послеоперационных осложнений у больных с аденомой простаты и хроническим простатитом

Aim: to assess the efficacy of personalized combined treatment for preventing postoperative complications after transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) that involves complex physiotherapy using “SMART-PROST” device considering individual chronobiological characteristics. Patients and Methods: 60 patients with BPH and CP who were referred for TURP were examined. α-blockers and fluoroquinolones were prescribed for 28 days in the control group (n=30). Personalized complex therapy was additionally prescribed in the study group (n=30). Treatment efficacy was assessed at baseline (visit 1), after two weeks (visit 2), and after four weeks (visit 3). The severity of lower urinary tract symptoms, prostate volume and postvoid residual volume, and prostatic hemodynamics were evaluated. Additionally, expressed prostatic secretion bacterioscopy and culture and TURP specimen histology were performed. Results: significant differences (p&lt;0.05) in all clinical laboratory tests and prostatic hemodynamics were demonstrated between the groups by the end of week 4. Histology of TURP specimens revealed more severe fibrosis and inflammatory infiltration in the control group. During a 6-month follow-up, acute urinary retention was detected in 2 patients (6.7%), leukocytes in the urine in 18 patients (60%), blood in the urine in 5 patients (16.7%), and bacteria in the urine in 14 patients (46.7%) of the control group. Meanwhile, acute urinary retention was detected in 1 patient (3.3%), leukocytes in the urine in 10 patients (33.3%), blood in the urine in 2 patients (6.7%), and bacteria in the urine in 7 patients (23.3%) of the study group. Conclusion: personalized combined therapy for BPH and CP reduced the severity of lower urinary tract symptoms and the signs of prostatic inflammation, improved prostatic hemodynamics, and increased the efficacy of antibacterial therapy as demonstrated by bacteriological tests. KEYWORDS: chronic prostatitis, benign prostatic hyperplasia, TURP, chronotherapy, personalized combined physiotherapy, TRUS, Doppler ultrasound, immunohistochemistry. FOR CITATION: Barannikov I.I., Kuzmenko A.V., Kuzmenko V.V., Gyayrgiev T.A. Efficacy of personalized combined treatment for preventing postoperative complications in patients with benign prostatic hyperplasia and chronic prostatitis. Russian Medical Inquiry. 2021;5(3):110– 117. DOI: 10.32364/2587-6821-2021-5-3-110-117.

The Predictive Role of Prostate-Specific Antigen Changes Following Transurethral Resection of the Prostate for Patients with Localized Prostate Cancer.

Simple SummaryA part of localized prostate cancer (PC) was an incidental finding in patients who received transurethral resection of the prostate (TURP) for urinary symptoms. The present study examined whether changes in prostate-specific antigen (PSA) levels after TURP possess a predictive value for localized PC. Our data revealed that patients at intermediate risk who are associated with tumor involvement ≤5% in TURP specimens, PSA_TURP ≤ 4 ng/mL, and ≥68% PSA reduction following TURP might be suitable for conservation management instead of immediate local therapy. Moreover, for patients with no pre-TURP PSA, Gleason score (GS) < 7, and low PSA_TURP could potentially be utilized to select which patients could be considered for conservative management after TURP. The findings suggest the pathologic finding of TURP and changes in PSA could be used as adjuvant markers to guide a risk-adaptive strategy for patients with localized PC.Regarding localized prostate cancer (PC), questions remain regarding which patients are appropriate candidates for conservative management. Some localized PC was an incidental finding in patients who received transurethral resection of the prostate (TURP) for urinary symptoms. It is known that TURP usually affects the level of prostate-specific antigen (PSA). In the present study, we examined whether changes in PSA levels after TURP possess a predictive value for localized PC. We retrospectively reviewed the clinical data of 846 early-stage PC patients who underwent TURP for urinary symptoms upon diagnosis at our hospital. Of 846 patients, 687 had tumor involvement in TURP specimens, and 362 had post-TURP PSA assessment. Our data revealed that, in addition to low GS and PSA levels at diagnosis, ≤5% tumor involvement in TURP specimens, greater PSA reduction (≥68%) following TURP, and post-TURP PSA ≤ 4 were significantly associated with better progression-free survival (PFS). Survival analysis revealed that the addition of prostate-directed local therapy significantly improved PFS in intermediate- and high-risk groups, but not in the low-risk group. Moreover, in the intermediate-risk group, local therapy improved PFS only for patients who were associated with post-TURP PSA > 4 ng/mL or <68% PSA reduction following TURP. We also found that local therapy had no obvious improvement in PFS for those with post-TURP ≤ 4 ng/mL regardless of pre-TURP PSA. In conclusion, conservative management is considered for patients at low or intermediate risk who have greater PSA reduction following TURP and low post-TURP PSA. Therefore, the levels of PSA following TURP might be helpful for risk stratification and the selection of patients for conservative management.

Relation of Age and Serum Prostatic-Specific Antigen level with Histopathological diagnosis in Transurethral Resection of Prostate specimen, an Experience from Eastern Tertiary Hospital

Background: Prostatic Specific Antigen (PSA) is a protease secreted by epithelial cells of prostate. Serum PSA level is increased when the normal structure of gland is destroyed by benign or malignant tumor or inflammation. Though there is established relation between PSA plasma level and age among the two most common prostate diseases (Benign prostatic hyperplasia and Carcinoma Prostate) in the literature, relation has not been explored in our part of the world, therefore, this study was done to see the relation between age and PSA amount with Prostate diseases.&#x0D; Material and Methods: This was a Cross-sectional study conducted in a tertiary hospital, Nobel Medical College Teaching Hospital from January 2017 to December 2018. Ethical clearance was obtained from Institutional Review Committee (IRC). All the cases of prostate diseases presenting to urology department undergoing transurethral resection of the prostate (TURP) were included. Histopathology report of TURP specimen were collected from department of pathology and the relationship between diagnosis, PSA level and age were established.&#x0D; Results: BPH was the most common diagnosis (72.41%). Age of BPH patients ranged from 48-78 years and mean age with SD was 60.56±7.32. Median age with interquartile range was 61.00. Similarly, in the BPH group, PSA value ranged between 0.80-15.40 ng/ml with mean PSA value along with SD being 5.64±4.16 ng/ml. Similarly, Median PSA value with interquartile range was 4.20ng/ml. Carcinoma Prostate (27.59%) was the second most common diagnosis. Histological type of all cases diagnosed as cancer was adenocarcinoma. Their age ranged between 54-83. Their mean age with SD was 67.67±7.68. Similarly, Median age with interquartile range was 68.00. PSA value in this group ranged between 8.50-147.30 ng/ml. Again, the mean PSA value with SD is 55.72±33.40 ng/ml. Similarly, Median PSA value with interquartile range is 54.30 ng/ml.&#x0D; Conclusion: PSA level in the blood of men over 40years is highly correlated with a Age, irrespective of diagnosis. In above 40 age group, with advancing age, Carcinoma Prostate becomes more and more common diagnosis than BPH. Similarly, average PSA level is higher in Carcinoma Prostate than BPH.

Histomorphological study of prostatic adenocarcinoma and its mimics.

Prostate adenocarcinoma (PC) is one of the common cancers in India and world over. Numerous prostatic, nonprostatic lesions, and normal structures can be very similar to adenocarcinoma. A pathologist's awareness of the benign mimics is important for the diagnosis of PC. The aim of this study was to determine the prevalence, clinical, and histopathological features of PC, and its common mimics, and to study the criteria for their distinction from PC. A prospective study of histopathological features of radical prostatectomy and transurethral resection of the prostate specimens, sent to the department of pathology in a medical college, for a period of 2 years was done. A brief clinical history followed by a clinical examination, including per-rectal findings and serum prostate-specific antigen (PSA) levels, was noted. After excluding all the cases of benign hyperplasia of prostate without any associated findings, 50 cases of operated surgical specimens of prostate were studied. PC was the most frequent diagnosis in 28 patients of 50 cases (56.0%). Basal cell hyperplasia formed the predominant mimic (26.0%), followed by prostatic intraepithelial neoplasia (8%), prostate atrophy (4%), clear-cell cribriform hyperplasia(4%),, and one case of atypical adenomatous hyperplasia (2%). Serum PSA was >4 ng/mL in all the cases of PC. In three of the mimics, PSA was >4 ng/mL and in the rest it was <4 ng/mL. Immunohistochemistry (IHC) was not applied in our study. Biopsy still remains a gold standard for diagnosis of PC and its mimics. All the lesions in the above study were diagnosed on routine hematoxylin and eosin staining. IHC is useful especially for lesions in the grey zone but not in routine histopathological study and should not be used as a screening test but should be applied in specific selected cases only.

The retrospective analysis of clinical features, treatment and prognosis of incidental prostate cancer

Objective To explore the clinical feature, treatment and prognosis of incidental prostate cancer(IPC) after transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Methods From January 2009 to April 2017, 24 cases undergoing TURP for benign prostatic hyperplasia and being diagnosed with prostate cancer( T1a-T1b) was retrospectivey analysed, who aged from 62 to 84 years (mean 71.8 years). Digital rectal examination(DRE) showed prostate medium texture, smooth surface, and no nodules. Ultrasound presented no low echo nodules in the prostate. Prostate volumes were 19.2-93.4 ml , with median of 40.1 ml. PSA were 1.81-9.11ng/ml, with median of 4.12 ng/ml. The patients with PSA between 6-10 ng/ml accepted prostate biopsy, and pathological results were negative. Results The The pathology of TURP specimens in 24 cases were diagnosed prostate cancer (21 cases of T1a, 3 cases of T1b). According to the new WHO/ISUP classification group, there were 18 cases of hierarchical group 1 , 3 cases of hierarchical group 2, 1 case of hierarchical group 3, 2 cases in hierarchical group 4. All patients were treated with hormonal therapy, and 7 cases (5 cases of hierarchical group 1, and 2 cases of hierarchical group 2) underwent laparoscopic radical prostatectomy(LRP) after 3 months of hormonal therapy. The specimens of prostatectomy were examined by whole-mount serial, showing 3 cases of prostate cancer (T1a) with negative margin, and 4 cases of benign prostate cells. They were followed up for 5-82 months with median of 43.5 months. No biological progression or tumor progression was found, and, 1 case died of colon cancer after 26 months of follow-up. The patients’ age and Gleason score of stage T1b were higher than that of stage T1a. Prostate volume and preoperative PSA had no statistically significant difference between the two stages. Conclusions The patients’ age and Gleason score of stage T1b were higher than that of stage T1a. The proportion of residual tumor following TURP was high. The prognosis of incidental prostate cancer was good by hormonal therapy or radical prostatectomy. Key words: Prostatic neoplasms, incidental; Hormonal therapy; Radical prostatectomy; Prognosis

Mucinous and secondary tumors of the prostate

Primary mucinous tumors and secondary tumors involving the prostate gland are relatively uncommon, however they have important diagnostic, therapeutic, and prognostic implications. The primary mucinous tumors of the prostate include mucinous (colloid) adenocarcinoma of the prostate, prostatic adenocarcinoma with mucinous features, and mucinous adenocarcinoma of the prostatic urethra (mucin-producing urothelial-type adenocarcinoma of the prostate). Mucinous adenocarcinoma of the prostate is defined as a primary prostatic acinar tumor characterized by the presence of at least 25% of the tumor composed of glands with extraluminal mucin. This diagnosis can only be made in radical prostatectomy specimens. Recent studies have shown that these tumors have a similar or in some cases better prognosis than conventional prostatic adenocarcinoma treated by radical prostatectomy. The preferred terminology for tumors that are composed of <25% extraluminal mucinous component in radical prostatectomy specimens is 'prostatic adenocarcinoma with mucinous features.' All cases of prostatic adenocarcinoma with extraluminal mucinous components in prostate needle core biopsies or transurethral resection of the prostate specimens are also referred to as 'prostatic adenocarcinoma with mucinous features.' Mucinous adenocarcinoma of the prostatic urethra (mucin-producing urothelial-type adenocarcinoma of the prostate) as the name implies, does not arise from prostatic acini or ducts, and is a distinct entity that arises from the prostatic urethra usually from urethritis glandularis or glandular metaplasia with malignant transformation, and is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. This tumor is aggressive and has a relatively poor prognosis. The most common secondary tumors that arise from adjacent organs and spread (direct extension or metastasis) to the prostate gland, include urothelial carcinoma of the bladder and colorectal adenocarcinoma. Other secondary tumors that may involve the prostate include metastatic epithelial tumors from several other sites, malignant melanoma and soft tissue tumors.

RELATIONSHIP OF PERIURETHRAL FIBROTIC IN BPH PATIENT WITH LUTS AND URINARY RETENTION

Objective: Analyzing the differences between collagen thicknesses in periurethral region from transurethral resection of the prostate (TURP) specimens of Benign Prostate Hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) and of those with urinary retention. Material &amp; methods: This was an observation analytic study on 30 patients who underwent TURP. Patients who met the inclusion criteria were divided into 2 groups: BPH patients with LUTS and those with urinary retention. Each group consisted of 15 people. The first TURP specimen of proximal verumontanum resection were examined in anatomic pathology using mass on strichrome staining as an examination of periurethral collagen thickness. Collagen will be stained as blue. Periurethral collagen thickness was measured from the basal membrane of transitional epithelium to fibromuscle tissue. Data were then statistically analyzed using independent t-test. Results: The average patient age was 66 ± 7 years old and there was no significant difference between age and periurethral collagen thickness with p=0.175 (p&gt;0.05). The mean prostate volume was 47.19 ± 13.2 ml and there was no significant difference between prostate volume and periurethral collagen thickness with p=0.148 (p&gt;0.05). Average periurethral collagen thickness in BPH patients with urinary retention was 146.67 ± 39.80 micrometers and while in those with LUTS was 205.33 ± 85.6 micrometers. There were no significant differences between periurethral collagen thickness and the occurrence urinary retention with retention of urine with p=0.063 (p&gt;0.05). Conclusion: There were no significant differences between periurethral collagen thickness patients in BPH patients with LUTS and in those with urinary retention. This suggests that periurethral collagen thickness is not associated with the occurrence of urinary retention or LUTS in BPH patients.

Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage Symptoms

To evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). From April 2011, a consecutive series of patients treated with TURP were prospectively included in this observational study. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Patients were evaluated at baseline and 1month postoperative with the International Prostate Symptom Score (IPSS), including the storage IPSS (sIPSS) and voiding IPSS (vIPSS) subscores, the Overactive Bladder questionnaire (OAB-q), and uroflowmetry. Prostate volume was evaluated at baseline. Complications were classified using the modified Clavien system. TURP specimens were examined to define grade, location, and extent of the inflammatory infiltrate according to the standardized classification system of chronic prostatitis and/or chronic pelvic pain syndrome. One hundred and thirty-one subjects were enrolled, in which 54 patients (41.3%) presented with MetS. No differences were observed in terms of preoperative prostate-specific antigen, OAB score, IPSS, vIPSS, sIPSS, Qmax, post void residual, and prostate volume in subjects with and without MetS. An incidence of postoperative complications of 10.6% was recorded: 79% were classified as Clavien type I or II; 21% Clavien IIIb. Of 131 subjects, 97 (74.1%) presented with an inflammatory infiltrate. Patients with MetS presented a high proportion of inflammatory infiltrates compared to patients without MetS (45 of 54; 83% vs 52 of 77; 67%, P= .01). Patients with prostate inflammation presented a 50% risk reduction of postoperative storage urinary symptoms. We confirmed the association between MetS and prostate inflammation.Patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms.

Molecular differences in transition zone and peripheral zone prostate tumors.

Prostate tumors arise primarily in the peripheral zone (PZ) of the prostate, but 20-30% arise in the transition zone (TZ). Zone of origin may have prognostic value or reflect distinct molecular subtypes; however, it can be difficult to determine in practice. Using whole-genome gene expression, we built a signature of zone using normal tissue from five individuals and found that it successfully classified nine tumors of known zone. Hypothesizing that this signature captures tumor zone of origin, we assessed its relationship with clinical factors among 369 tumors of unknown zone from radical prostatectomies (RPs) and found that tumors that molecularly resembled TZ tumors showed lower mortality (P = 0.09) that was explained by lower Gleason scores (P = 0.009). We further applied the signature to an earlier study of 88 RP and 333 transurethral resection of the prostate (TURP) tumor samples, also of unknown zone, with gene expression on ~6000 genes. We had observed previously substantial expression differences between RP and TURP specimens, and hypothesized that this might be because RPs capture primarily PZ tumors, whereas TURPs capture more TZ tumors. Our signature distinguished these two groups, with an area under the receiver operating characteristic curve of 87% (P < 0.0001). Our findings that zonal differences in normal tissue persist in tumor tissue and that these differences are associated with Gleason score and sample type suggest that subtypes potentially resulting from different etiologic pathways might arise in these zones. Zone of origin may be important to consider in prostate tumor biomarker research.

Preoperative parameters to predict incidental (T1a and T1b) prostate cancer.

Prostate cancer has been found incidentally in transurethral resection of the prostate (TURP) specimens without prior diagnosis in 5% to 13% of the patients. We evaluated whether incidental prostate cancer (stages T1a and T1b) could be predicted preoperatively. TURP was performed in 307 patients between 2006 and 2011. Patient age, prostate-specific antigen (PSA) level, total prostate volume, transitional zone volume, PSA density, history of needle biopsy, and pathological diagnosis on TURP specimen were assessed. We analyzed the association between these parameters and prostate cancer detection. Incidental prostate cancer was found in 31 patients (10.1%), and 13 cases (4.2%) had cancer with T1b and/or Gleason ≥7. Multivariate analysis demonstrated that age ≥75 years (odds ratio [OR] 2.58, p = 0.022), prostate volume ≤50 cc (OR 4.11, p < 0.001), and the absence of preoperative needle biopsy despite PSA ≥4 ng/mL (OR 2.65, p = 0.046) were independent risk factors. In patients who had 2 or 3 of these risk factors, incidental prostate cancer and cancer with T1b and/or Gleason ≥7 were observed in 25% to 50% and 16% to 25% cases, respectively. Older patient age, small prostate volume, and the absence of previous needle biopsy (despite a high PSA level) might be independent risk factors for detecting incidental prostate cancer, although external validation is warranted to confirm our results.

PD25-10 CHARACTERIZATION OF FIBRILLAR COLLAGENS AND EXTRACELLULAR MATRIX OF GLANDULAR BENIGN PROSTATIC HYPERPLASIA NODULES

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation & Markers1 Apr 2014PD25-10 CHARACTERIZATION OF FIBRILLAR COLLAGENS AND EXTRACELLULAR MATRIX OF GLANDULAR BENIGN PROSTATIC HYPERPLASIA NODULES Tyler Bauman, Tristan Nicholson, Brett Becker, Wei Huang, and William Ricke Tyler BaumanTyler Bauman More articles by this author , Tristan NicholsonTristan Nicholson More articles by this author , Brett BeckerBrett Becker More articles by this author , Wei HuangWei Huang More articles by this author , and William RickeWilliam Ricke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1989AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies have associated prostatic fibrosis with lower urinary tract symptoms (LUTS) independent of hyperplasia, indicating that fibrosis may be important in evaluating benign prostatic hyperplasia (BPH). However, collagen and extracellular matrix (ECM) composition within the normal and hyperplastic prostate have not previously been characterized. The purpose of this study was to evaluate collagen and ECM in normal prostate tissue and in glandular BPH, as well as the effects of therapies on these parameters. METHODS Fibrillar collagen and ECM were assessed in prostate tissues stained for picrosirius red (PSR) and Masson’s trichrome (MTC), respectively, using a tissue microarray (TMA) with glandular BPH tissue from patients with LUTS and normal prostate tissue from prostatectomy specimens. Additional tissues from BPH patients who underwent transurethral resection of the prostate (TURP) were assessed from patients treated with 5α-reductase inhibitors (5α-RIs) (n = 22) ± α-blockers (n = 38). Images were acquired and tissues were quantified in ImageJ. RESULTS Total collagen staining, quantified by birefringence of PSR-stained tissues viewed under circularly polarized light, was similar in normal prostate tissue (n = 48) and glandular BPH (n = 23) (125.9 ± 4.9 vs. 111.9 ± 5.1; p = 0.08). Differences of collagen bundle size were also assessed and no differences were observed. No differences were observed in the quantity of ECM in normal and BPH tissue quantified with MTC (12.97 ± 1.03 vs. 10.20 ± 1.24; p = 0.11). Collagen staining intensity was not associated with age (p = 0.63). In tissues from TURP specimens, treatment with 5α-RIs (p = 0.71) or α-blockers (p = 0.69) had no effect on total collagen staining (n = 47). Collagen staining was not associated with age (p = 0.61), pre-TURP prostate-specific antigen (p = 0.87), pre-TURP AUA symptom index (p = 0.11), or pre-TURP post-void residual (p = 0.67). CONCLUSIONS The association between fibrosis and LUTS that has been demonstrated in previous studies cannot be explained by increased fibrillar collagen or extracellular matrix deposition in glandular BPH nodules. If fibrosis is associated with BPH/LUTS, it is likely affecting collagen and ECM deposition within the periurethral tissue independent of nodular BPH. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e729 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Tyler Bauman More articles by this author Tristan Nicholson More articles by this author Brett Becker More articles by this author Wei Huang More articles by this author William Ricke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidental prostate cancer in transurethral resection of the prostate specimens in the modern era.

Objectives. To identify rates of incidentally detected prostate cancer in patients undergoing surgical management of benign prostatic hyperplasia (BPH). Materials and Methods. A retrospective review was performed on all transurethral resections of the prostate (TURP) regardless of technique from 2006 to 2011 at a single tertiary care institution. 793 men (ages 45–90) were identified by pathology specimen. Those with a known diagnosis of prostate cancer prior to TURP were excluded (n = 22) from the analysis. Results. 760 patients had benign pathology; eleven (1.4%) patients were found to have prostate cancer. Grade of disease ranged from Gleason 3 + 3 = 6 to Gleason 3 + 4 = 7. Nine patients had cT1a disease and two had cT1b disease. Seven patients were managed by active surveillance with no further events, one patient underwent radiation, and three patients underwent radical prostatectomy. Conclusions. Our series demonstrates that 1.4% of patients were found to have prostate cancer, of these 0.5% required treatment. Given the low incidental prostate cancer detection rate, the value of pathologic review of TURP specimens may be limited depending on the patient population.