Extraprostatic extension of gleason 6 prostate cancer: single center experience

Objective: For Gleason Score (GS) 3+3:6 prostate cancer (PC) cases, recent guidelines recommend clinical follow-up instead of radical treatment due to complications. One of the most important disadvantages of clinical follow-up is that low-grade PC may include local aggressive behavior. Hence, our aim here was to investigate the incidence of extraprostatic extension (EPE), a local aggressive behavior, in GS6 PC cases. Material and Methods: We examined 119 materials diagnosed with prostatic adenocarcinoma (GS 3+3:6) with no tertiary pattern and that were sent to our department as radical prostatectomy materials between January 2010 – May 2019. We investigated how many of the materials had EPE. Results: We observed EPE in 16 (13.45%) of our cases. 5 of the cases had vesicula seminalis invasion (pT3b) and 11 had EPE and/or bladder neck invasion (pT3a) without vesicula seminalis invasion. Conclusion: Among our patients diagnosed with GS-6 PC, we observed EPE (pT3) in 13.45% and vesicula seminalis invasion (pT3b) in 4.2%, which suggests that the possibility of EPE is not uncommon in GS-6 PC. Based on these findings, we argue that patients with GS-6 PC under clinical follow-up should be followed more carefully for EPE. Keywords: prostate cancer; gleason score; extraprostatic extension

Modern Approach in Radiological Diagnosis of Prostate Cancer (Systematic Review of International Clinical Guidelines and Clinical Studies Over 2014–2020)

An increase in the level of prostate-specific antigen requires additional examination of the patient in order not to subject him to unnecessary treatment in case of clinically insignificant prostate cancer and, conversely, to carry out the necessary volume of measures in case of clinically significant prostate cancer. The paper presents the modern solutions for effective usage of diagnostic methods in visualization of clinically significant prostate cancer. To assess the advantages and disadvantages of various methods for diagnosing prostate cancer a search of publications for 2014–2020 period was conducted based on the Scopus, Web of Science, PubMed databases. The request included keywords: prostate cancer, multiparametric MRI, multiparametric ultrasound, PSMA PET/CT. We selected 27 articles. The review includes guidelines from the European Association of Urology, the American Urological Society, the American College of Radiology, and one practice recommendation.

Down-regulation of F-actin and paxillin by N-(3-(1Htetrazol- 1-yl)phenyl) isonicotinamide derivative inhibits proliferation of prostate cancer cells

Purpose: To investigate the effect of N-(3-(1H-tetrazol-1-yl)phenyl) isonicotinamide derivative (TPIN) on prostate cancer cells, and the mechanism involved.Methods: The cytotoxicity of TPIN in DU145 and PC3 cells was determined using Cell Counting Kit-8, while apoptosis induction was assayed by flow cytometry using Annexin V-fluorescein isothiocyanate dye. Changes in expressions of F-actin, RAC-α and paxillin were determined by western blot assay.Results: Cell proliferation was effectively inhibited by TPIN in the concentration range of 0.75-15 μM. The values of half-minimum inhibitory concentration (IC50) of TPIN for DU145 and PC3 cells at 48 h were 5.6 and 10.2 μM, respectively (p < 0.05). Treatment with 5.6 μM TPIN increased apoptosis to 59.64 % in DU145 cells, and 54.21% in PC3 cells. Cleaved caspase-3 and caspase-9 levels were increased by TPIN treatment in both cell lines (p < 0.05). Moreover, the levels of F-actin and paxillin were significantly downregulated by TPIN treatment in DU145 and PC3 cells (p < 0.05). In TPIN-treated DU145 and PC3 cells, cofilin-1expression was up-regulated, relative to control cells.Conclusion: TPIN exhibits cytotoxic effect on prostate cancer cells via activation of apoptosis. It elevates cofilin-1 and the expressions of targets F-actin and paxillin in prostate cancer cells. Thus, TPIN is a potential chemotherapeutic agent for prostate cancer. However, further investigations, including clinical trials are required to authenticate these findings. Keywords: Prostate cancer, F-actin, Paxillin, Apoptosis, Caspases

Prostate hyperplasia in St Mary’s Hospital Lacor: utility of prostate specific antigen in screening for prostate malignancy

Introduction: Prostate cancer is the second commonest cancer in men worldwide. At present, every patient with lower urinary tract symptoms (LUTS) in St. Mary’s Hospital Lacor is undergoing prostate biopsy regardless of the prostate specific antigen (PSA) level. We sought to determine the association between PSA and malignant prostate histology. Methods: This was a retrospective study. Data on age, PSA, prostate volume and prostate histology reported between Jan 2012 and Dec 2019 were retrieved from St. Mary’s Hospital Lacor archive and analyzed using STATA SE/13.0. Results: Records of 97 patients with LUTS was analyzed. The median (range) age of the patients was 71 (43-100) years. Median (range) of prostate volume was 91.8 (8.0-360.0) cc. Overall, PSA ranged from 0.21 to 399.2 ng/ml. Prostate histology showed 3.1% acinar adenocarcinoma, 24.7% adenocarcinoma and 72.2% benign prostatic hyperplasia. The median PSA amongst pa- tients with malignant and non-malignant prostates were 15.8 ng/ml and 6.07 ng/ml respectively. Serum PSA level was signifi- cantly higher in patients with malignant prostate histology (Difference of mean= 9.7; p=0.001). Conclusion: Patients with LUTS and PSA levels of 15ng/ml or more were more likely to have malignant prostate histology. Keywords: Prostate specific antigen; Prostate cancer.

PROSTATIC STROMAL SARCOMA: RARE CASE REPORT

Prostatic stromal sarcoma is rare and aggressive malignant mesenchymal tumor accounting for 0.1- 0.2% of all prostate malignancy. Here we report a case of middle aged male with lower urinary tract symptoms and normal PSA levels. Ultrasonography findings showed grade 3 prostatomegaly. An open prostatectomy specimen was sent and a diagnosis of Prostatic Stromal Sarcoma was made based on histopathological and immunohistochemical findings. Keywords: Prostate, Stromal sarcoma, mesenchymal

INCIDÊNCIA E MORTALIDADE POR CÂNCER DE PRÓSTATA NO TOCANTINS E PALMAS, NO PERÍODO DE 2010 A 2014.

OBJETIVO: Realizar um levantamento acerca da incidência e mortalidade por câncer de próstata no Estado do Tocantins e na cidade de Palmas, no período entre 2010 e 2014. MATERIAIS E MÉTODOS: Realizado estudo retrospectivo utilizando como fonte de dados às estimativas para o biênio 2016-2017 do INCA e o Atlas Online de Mortalidade. Foram considerados, para critério de inclusão, os pacientes que tiveram como causa do óbito o câncer de próstata em todas as idades, sendo analisada a abrangência no Brasil e no Estado do Tocantins. Para o tabulamento dos dados, foi considerada a distribuição por faixa etária, selecionando-se o ano, a região, e a classificação do tumor primário de acordo com o Código Internacional de Doenças, CID-10 C61, que corresponde à neoplasia maligna de próstata. RESULTADOS: Em valores absolutos, durante o período de 2010 a 2014, o total de mortes em decorrência do câncer de próstata, foi de 513. Em análise por faixa etária, não foram registrados óbitos em idade de 0 a 29 anos, observando-se mortalidade apenas a partir dos 30 anos de idade. Segundo a Atlas Online de Mortalidade do INCA, o câncer de próstata foi a neoplasia com maior mortalidade nos anos de 2010 a 2014 no Estado do Tocantins, sendo a maior taxa de 18,08 por 100 mil homens, no ano de 2014. CONCLUSÃO: O câncer de próstata é a neoplasia que mais mata os homens no Brasil, especialmente os indivíduos de idade mais avançada, essa realidade também se faz presente no estado do Tocantins. A idade avançada e o histórico familiar, apresentam –se como as principais causas, mostrando a necessidade de uma política de saúde voltada para esses grupos específicos que esteja focada nas estratégias de prevenção e o diagnóstico precoce. Palavras-chave: câncer de próstata, mortalidade, neoplasia. ABSTRACT OBJECTIVE: To carry out a survey about the incidence and mortality of prostate cancer in the state of Tocantins and in the city of Palmas, between 2010 and 2014. MATERIALS AND METHODS: A retrospective study was carried out, based on the estimates for the biennium 2016-2017 and the Online Atlas of Mortality. Patients of all ages who had prostate cancer as the cause of death were considered. In addition, the survey for the mortality of this pathology covers the incidence in Brazil and in the state of Tocantins. The distribution by age group was considered, and for the data tabulation, the year and region were also considered, the primary tumor being in accordance to the International Code of Diseases, ICD-10 C61, which corresponds to malignant neoplasm of the prostate. RESULTS: In absolute values, during the period from 2010 to 2014, the total number of deaths due to prostate cancer was 513. In analysis by age group, no deaths were recorded from 0 to 29 years old, observing mortality only after 30 years of age. According to the INCA’s Online Atlas of Mortality, prostate cancer was the neoplasm with the highest mortality in the years of 2010 until 2014 in the state of Tocantins, with the highest rate of 18.08 per 100 thousand men in 2014. CONCLUSION: Prostate cancer is the neoplasm that most kills men in Brazil, especially the elderly. This reality is also present in the state of Tocantins. Old age and family history are presented as the main causes, which shows the need for a health policy focused on these specific groups, more specifically, on prevention strategies and early diagnosis. Keywords: prostate cancer, mortality, neoplasm.

Aspek Histopatologik Adenokarsinoma Prostat

<p><strong>Introduction: </strong>Prostate carcinoma is the second most common tumor in male, 95% in which made up from adenocarcinoma. The diagnosis of prostate adenocarcinoma through a needle biopsy specimen plus the determination of tumor staging are paramount in selecting the therapy and management. This study is done to know the morphologic variation of prostate adenocarcinoma in the needle biopsy as well as to measure the grading compatibility between the needle biopsy and prostatectomy using Gleason scoring system.</p><p><strong>Materials and Method: </strong>This retrospective study is conducted through form and specimen slides compilement. The specimens, consisting of prostate adenocarcinoma’s needle biopsy and prostatectomy, were gathered from the archives of Pathological Anatomy Departement, Faculty of Medicine, University of Indonesia in the year of 2008-2013. The slides were re-read and the morphologic appearance’s variation was valued. Gleason scoring was also executed from the pairing specimen according to <em>International Society of Urological Pathology</em> (ISUP) 2010.</p><p><strong>Result: </strong>Out of 114 needle biopsy cases, the morphologic variation was found to be perineural invation (n=38), mucinous fibroplasia (n=1), glomerulation (n=1), mucinous basophilic (n=25), and eosinophilic crystal (n=5). The amount of patient that was performed both specimen is 11, and there is a compatibility between biopsy score and prostatectomy as much as 63.63% and the median is 7.</p><p><strong>Conclusion: </strong>It is requisite to know the morphological variation in prostate adenocarcinoma in the biopsy needle specimen to get an accurate diagnosis. Undergrading in biopsy specimen is as much as 36.36%, owing to the fact that prostate carcinoma can be manifested as mutifocal lesion, thus the higher grading can only be found in prostatectomy specimen, for the needle biopsy was inadequately taken.</p><p><strong>Keywords: prostate adenocarcinoma, morphological view, Gleason score</strong></p>

Profil penderita kanker prostat di RSUP Prof. Dr. R. D. Kandou Manado periode tahun 2013–2015

Prostate cancer is a malignant disease of urogenital system which is the second most common type of cancer in men after lung cancer. Prostate cancer is also one of the most common cause of death in male population. There is no database regarding profiles of prostate cancer in Manado. This study was aimed to determine the profile of prostate cancer patients treated at Prof. Dr. R. D. Kandou Hospital Manado in the period 2013 to 2015. This was a descriptive retrospective study in October to November 2016. Samples were taken based on secondary data of the medical record. The results showed that there were 54 patients with prostate cancer, most were found in 2015 (38.9%), age group 61-70 years old (37.0%), lived in Manado (33.3%), graduated Senior High School (64.8%), retirees (50.0%), difficult urination (44.4%), PSA levels >100 ng/ml (50.0%), histopathological of adenocarcinoma (100.0%), and Gleason score ranging from 8-10 (46.7%). Based on metastasis, 14 patients had metastasis (25.9%).Keywords: prostate cancer, profile, PSA, histopatology, Gleason score Abstrak: Kanker prostat ialah penyakit keganasan sistem urogenital yang merupakan kanker kedua terbanyak pada pria setelah kanker paru. Kanker prostat juga merupakan salah satu penyebab terbanyak kematian pada populasi pria. Belum ditemukan data tentang profil kanker prostat di Manado. Penelitian ini bertujuan untuk mengetahui profil penderita kanker prostat yang dirawat di RSUP Prof. Dr. R. D. Kandou pada periode 2013–2015. Jenis penelitian ialah deskriptif retrospektif yang dilakukan pada bulan Oktober sampai November 2016. Sampel diambil berdasarkan data sekunder dari catatan rekam medik. Hasil penelitian mendapatkan 54 penderita kanker prostat, paling banyak ditemukan pada tahun 2015 (38,9%), kelompok usia 61-70 tahun (37,0%), berdiam di Kota Manado (33,3%), tamat SMA (64,8%), pensiunan (50,0%), keluhan utama sulit buang air kecil (44,4%), kadar PSA >100 ng/ml (50,0%), jenis adenokarsinoma (100,0%), dan skor Gleason 8-10 (46,7%). Berdasarkan metastasis, sebanyak 14 penderita (25,9%) mengalami metastasis. Kata kunci: kanker prostat, profil, psa, histopatologi, skor gleason

PSA testing in general practice

INTRODUCTION: In New Zealand, prostate-specific antigen (PSA) testing has increased significantly (275 000 tests/year). Controversy exists around PSA testing as part of an unorganised screening programme. AIM: To look at the use of PSA testing in a sample of general practices and investigate the reasons GPs undertake PSA testing. METHODS: Five Waikato general practices investigated looking at PSA laboratory tests of men =40 years in 2010 compared against GP notes. Testing rates, reasons for testing, histology and referral/s were examined for different age groups. A questionnaire was sent to the GPs to determine their views on PSA testing. RESULTS: One in four men aged 40+ years had a PSA test in 2010. Of these men, 71% were asymptomatic. More than half of men tested aged 70+ years were asymptomatic. Ten percent of all PSA tests were elevated. Twenty-one of 23 prostate cancers were diagnosed following an elevated PSA test: more than 80% of these men had histories of prostate pathology or lower urinary tract symptoms. The questionnaire confirmed that GPs believe in the benefits of PSA screening and it also showed they had difficulty in providing patients with information about pros and cons of PSA testing. DISCUSSION: All GPs in this study tested asymptomatic men. GPs in this study value PSA screening and believe that it reduces mortality rates. However, although PSA tests were most frequently done on asymptomatic patients, the majority of patients subsequently diagnosed with prostate cancer had been tested because of symptoms or had previous prostate problems. KEYWORDS: Prostate specific antigen (PSA); PSA testing; screening; prostate cancer; general practitioners

Molecular analysis of multifocal prostate cancer cases

Background. Prostate cancer (PCa) is usually a multifocal disease with different foci displaying histological and molecular heterogeneity. Biopsy-based pathology diagnosis of PCa may not be representative of the entire tumour; thus, markers more precisely characterizing every focus of multifocal PCa are highly instrumental for a better testing of PCa. Materials and Methods. Two distant foci of prostate adenocarcinoma were obtained from prostatectomy specimens of ten patients with pT2–pT3 stage PCa. The expression of TMPRSS2 : ERG, TMPRSS2 : ETV1, and TERT was assessed by means of reverse transcription PCR and quantified using the real-time-based approach. Ki-67, ERG, EMA, AMACR, p16, and p53 expression was evaluated by means of immunohistochemistry (IHC) on tissue microarrays (TMA). Results. Two out of ten cases were identified with different Gleason scores in paired foci of PCa. The expression of most of the IHC markers was quite even between TMA cores of each PCa case, with p16 showing the highest level of heterogeneity (44%; 4/9); 80% (8/10) of multifocal PCa expressed different variants of the TMPRSS2 : ERG transcript or showed a varying status of fusion positivity in paired foci, and the expression levels of the transcript were also heterogeneous. Similarly, 90% (9/10) of PCa showed a different positivity for TERT expression in paired foci. Conclusions. Measurement of TMPRSS2 : ERG and TERT expression offers a valuable tool for identifying most aggressive tumour foci and selecting a relevant treatment of PCa. Keywords: prostate cancer, multifocality, TMPRSS2 : ERG, telomerase