- Email: [email protected]
260 Isolated mono- and pluri-focal high grade prostatic intraepithelial neoplasia (HGPIN) on initial extended prostate needle biopsies: factors predicting cancer detection on extended re-biopsy
258
257 DO AFRICAN PROSTATE KINGDOM?
CARIBBEAN MEN PRESENT CANCER THAN CAUCASIAN
Enver M.‘, Lee A.1, Kapoor Chinegwundoh F.‘,
S.‘, Otite
U.‘,
WITH MEN
Pati J.‘, Oliver
ROLL OF P63 AND ATYPICAL LESIONS 65 CASES
MORE ADVANCED IN THE UNITED T.2, Ben-Shlomo
‘St Bartholomew’s Hospital, Urology, London, United Bartholomew’s Hospital, Oncology, London, United Kingdom, Bristol, Department of Social Medicine, Bristol, United Kingdom
Y.3
Kingdom, 3University
*St of
INTRODUCTION & OBJECTIVES: Black African American prostate cancer patients present with more advanced disease than Caucasians. Differences in mortality persist even after correcting for socioeconomic factors. The largest immigration of African Caribbean’s to the UK took place in the 1950s and 6Os, and was mainly into the larger cities. This population will soon reach the age where the incidence of prostate cancer is highest. However, there is very little data on prostate cancer in the African Caribbean population of the UK. In this study we sought to address this by investigating the incidence and presenting features of the ethnic populations of the East End of London. MATERIAL & METHODS: Population data was gathered from the East London Health Authority for the year 1999. Regional patient cancer data was collected from the Thames Cancer Registry, death certificates, hospital patient administration records, departmental databases, general practitioners, patient records, and patients and their relatives. All newly diagnosed prostate cancer patients in 1999 were identified. Age standardised incidences (European standard) were calculated, and PSA, Gleason grades and stage were compared in the white and black patients. RESULTS: The male population of ELCHA in 1999 was 3 15100. 184 patients with newly diagnosed prostate cancer were identified. Incidence of prostate cancer in the white population was 61 per 100,000 men and 180 per 100,000 in the African Caribbean population, a significant difference. There was no significant difference in presenting age, PSA, Gleason or stage. CONCLUSIONS: The age demographic and higher incidence of prostate cancer in African Caribbean’s will impact resources in all areas with large numbers of immigrants. Fortunately, the increase in numbers may not be associated with more advanced disease. There also appears to be no significant difference in the incidence of prostate cancer in immigrants of south Asian origin.
Vera Donoso Cruz J.F. ’
CK34 IN THE DIAGNOSIS OF HISTOLOGICALLY OF THE PROSTATE. COMPARATIVE STUDY
C.‘, Pefias Pardo L.‘, Salem Fuster J.V.2, Vera Sempere
iLa Fe University Hospital, Department Department University Hospital,
F.Z, Jimenez
of Urology, Valencia, Spain, of Pathology, Valencia,
OF
CHEMOPREVENTION IN PATIENTS WITH NEOPLASIA
ON HIGH
PSA AND CLINICAL GRADE PROSTATIC
Joniau S.‘, Goeman L.‘, Roskams T.‘; Oyen R.;, Van Poppel H.’
‘University Hospital Leuven, Department of Urology, Leuver+ Belgium, ‘University Hospital Leuven, Department of Pathology, Leuven, Belgum, YJniverslty Hospital Leuven, Depattment of Radiology, Leuven, Belgium INTRODUCTION & OBJECTIVES: High Grade Prostatic Intraepithelial Neoplasia IH.G.P.1.N.) is eenerallv accented to be a precursor lesion of mostate cancer. A nrosoective 6. tnonth f&w-up study-of IOdpatients with H.G.P.I.N. was p&formed to investi&te ihe effects of a short-term chemoprevention scheme on P.S.A. and clinical management. MATERIAL & METHODS: In a 2-year period, 100 men were included in a prospective trial, evaluating the effects of a short term Selenium-Vitamin E-Isoflavonoids supplement in patients diagnosed with H.G.P.I.N. on &ant biopsies of the prostate. 24 patients refused further biopsies. 76 underwent a second set of biopsies at 3 months (V2) and 62 underwent a third set of biopsies at 6 months (V3). In all but four patients (23127) in whom prostate cancer was found on V2 or V3 biopsies, a radical prostatectomy was done. RESULTS: Mean age at inclusion was 62.7 years (range 43-80) and mean total P.S.A. was 5.63 n&n1 (rant 0.23-31.9). At V2. a decrease in P.S.A. from baseline was observed in 64% of p&e&. Inyhis group, prostate c&er was found in 12.2% of men. In a further 36% of patients, an increase in P.S.A. from baseline was noticed. In this group, prostate cancer was found in 29.6% of men. At the end of the study (V2+V3), cancer was found in of 35.5% (n=27) of men, H.G.P.I.N. in 39.5% (n=30), isolated L.G.P.I.N. in 14.5% (n=ll), and no P.I.N. or carcinoma in 10.5% (n=8). The risk of finding cancer throughout the whole of the study was 26.5% in the group with a P.S.A..decrease from baseline (64% of patients) and 51.9% in the group with a P.S.A..increase from baseline (34% of patients). In patients who underwent a radical prostatectomy (n=23), pathological stage ranged from foci of micro-invasive carcinoma to pT3a. Gleason scores ranged from micro-invasive carcinoma to Gleason score 8. In the V2 group (n=l3), all but one patient had organ confined cancers (1 was pT3), 53.8% had a Gleason score of 7 or more and the incidence of significant cancers (volume of 0.5ml or more) was 69.2%. In the V3 group (n=lO), all cancers were organ-confined, 90% had a Gleason score less than 7 and 60% were insignificant cancers (volume i OSml). CONCLUSIONS: In the present group of patients diagnosed with H.G.P.I.N. and on a Selenium-Vitamin E-Isoflavonoids supplement, the risk of finding prostate cancer in a 6-months follow-up period was 35.5%. Interestingly, in a large subgroup (64%), P.S.A. decl-eased under supplement therapy. In this subgroup, the overall risk of finding cancer was only 26.5% compared to 51.9% in a smaller subgroup ofpatients (36%) in whom the P.S.A. continued to rise under supplements. Thus, close P.S.A. monitoring is mandatory in patients with H.G.P.I.N. who are on supplement therapy. A Selenium-Vitamin E-Isoflavonoids supplement is probably only of interest in those patients with a P.S.A. response. Long term studies are required to further validate this observation.
‘La Fe Spain
INTRODUCTION & OBJECTIVES: Identification of basal prostatic cells (BPC) is a diagnostic clue in atypical lesions of this gland suggesting malignancy. Until now, immunohistochemical study with 34PE12 is the standard method in this situation. In recent years, a new marker for basal cells of prostate has been described: ~63. In present study we evaluate the utility of both markers in the diagnosis and classification of these lesions. MATERIAL & METHODS: We have studied 65 biopsies of prostate evaluated by one pathologist. Cases were selected due to diagnostic doubts about their malignancy (24 patients) or due to the existence of atypical lesions nearby clear adenocarcinoma areas (41 cases). All cases were reviewed by a second pathologist in a retrospective way. Further, study with both markers p63 (Neomarkers, l/100) and 34pE.12 (Dako, 11100) was performed. Finally, two pathologists evaluated the efficacy of both markers for the detection of BPC and last diagnostic category. RESULTS: P63 antibody showed a higher efficacy and resolution than 34fiEl2 in the diagnosis of these cases (> 65% of cases). Also variability in immunostaining was lower with ~63. Information reached by these two markers allowed to establish a diagnosis in 75 % of cases studied. Initial estimation of tumour volume was increased in 30 % of cases by using these markers, offering p63 the highest increase (75 % of total). CONCLUSIONS: P63 is a useful marker of BPC in comparison with CK34SE12. It offers a better diagnosis of histologically atypical prostatic lesions and a more precise evaluation of the tumour volume in prostatic samples.
259 THE EFFECT MANAGEMENT INTRAEPITHELIAL
OF
260 ISOLATED MONOAND PLURI-FOCAL HIGH GRADE INTRAEPITHELIAL NEOPLASIA (HGPIN) ON INITIAL PROSTATE NEEDLE BIOPSIES: FACTORS PREDICTING DETECTION ON EXTENDED RE-BIOPSY Roscieno M.‘, Scattoni F.l, Rigatti P.’
‘University
V.‘, Freschi
“Vita-Salute”
M.*, Pasta A.‘, Colombo
Scientific
Institute
Milan, Italy, Wniversity “Vita-Salute” of Pathology, Milan, Italy INTRODUCTION & OBJECTIVES: via extended repeat prostate biopsies HGPIN diagnosis.
MATERIAL underwent
& METHODS: lo-12
systematic
From
PROSTATIC EXTENDED CANCER
R.‘, Bertini
R.‘. Montorsi
H. San Raffaele, Department of Urology, Institute H. San Raffaele, Department
Scientific
To evaluate factors predicting in patients with initial isolated
January,
TRUS-guided
1995, to June, 2002, biopsies.
At
least
five
cancer detection mono/pluri-focal
2,314 patients biopsies
were
performed in each lobe: in addition to sextant biopsies, cores were taken both from the far lateral region of the gland and the transition zone, depending on gland vo!ume (10 cores for prostate < 50 gr.; 12 cores in prostate ‘50 gr.). Forty-seven patients with initial HGPIN diagnosis were re-biopsied using the same technique (mean repeat biopsy cores: 11.5) after a median follow-up time of 11.4 months (range 3-24 months).
RESULTS: Cancer was detected on second biopsy in 21 patients (44.6%). Cancer detection was significantly higher in patients with pluri-focal HGPIN when compared to those with mono-focal HGPIN (70% vs. 10%; respectively) (p
more than 6 months after a first biopsy set (65%) when compared to patients before 6 months or less (25%) (~‘0.01; mean follow-up time 15.5 and 3.8
months, respectively). In a univariate analysis the mean PSAD (&SD) was statistically different in the two groups: 0.11 ho.05 and 0.25 hO.04, respectively; (p=O.O2). Multivariate analysis showed that Prostate Specific Antigen (PSA), PSA Density, Digital Rectal Examination and Transrectal Ultrasound findings were not significant predictors
of prostate cancer, while HGPIN multi-focality and re-biopsy h-month follow-up interval) were independent prognostic prostatectomy
(14 patients),
patient groups re-biopsied CONCLUSIONS: /pluri-focal HGPIN
there were no differences before or after 6 months.
Following
lo-to-12
diagnoses
had an overall
biopsies,
time lapse (more than a factors. After radical
at the pathological
patients
with
cancer detection
initial,
stage between
isolated
mono-
rate of 45% on repeat
extended biopsies. HGPIN’s pluri-focality on first biopsy and re-biopsy time interval are independent predictive factors in cancer detection. A 12-to-18 month re-biopsy follow-up should permit a significantly higher cancer detection rate; with no apparent likelihood of clinical cancer progression.
European
Urology
Supplements
3 (2004)
No. 2, pp. 67
257 DO AFRICAN PROSTATE KINGDOM?
CARIBBEAN MEN PRESENT CANCER THAN CAUCASIAN
Enver M.‘, Lee A.1, Kapoor Chinegwundoh F.‘,
S.‘, Otite
U.‘,
WITH MEN
Pati J.‘, Oliver
ROLL OF P63 AND ATYPICAL LESIONS 65 CASES
MORE ADVANCED IN THE UNITED T.2, Ben-Shlomo
‘St Bartholomew’s Hospital, Urology, London, United Bartholomew’s Hospital, Oncology, London, United Kingdom, Bristol, Department of Social Medicine, Bristol, United Kingdom
Y.3
Kingdom, 3University
*St of
INTRODUCTION & OBJECTIVES: Black African American prostate cancer patients present with more advanced disease than Caucasians. Differences in mortality persist even after correcting for socioeconomic factors. The largest immigration of African Caribbean’s to the UK took place in the 1950s and 6Os, and was mainly into the larger cities. This population will soon reach the age where the incidence of prostate cancer is highest. However, there is very little data on prostate cancer in the African Caribbean population of the UK. In this study we sought to address this by investigating the incidence and presenting features of the ethnic populations of the East End of London. MATERIAL & METHODS: Population data was gathered from the East London Health Authority for the year 1999. Regional patient cancer data was collected from the Thames Cancer Registry, death certificates, hospital patient administration records, departmental databases, general practitioners, patient records, and patients and their relatives. All newly diagnosed prostate cancer patients in 1999 were identified. Age standardised incidences (European standard) were calculated, and PSA, Gleason grades and stage were compared in the white and black patients. RESULTS: The male population of ELCHA in 1999 was 3 15100. 184 patients with newly diagnosed prostate cancer were identified. Incidence of prostate cancer in the white population was 61 per 100,000 men and 180 per 100,000 in the African Caribbean population, a significant difference. There was no significant difference in presenting age, PSA, Gleason or stage. CONCLUSIONS: The age demographic and higher incidence of prostate cancer in African Caribbean’s will impact resources in all areas with large numbers of immigrants. Fortunately, the increase in numbers may not be associated with more advanced disease. There also appears to be no significant difference in the incidence of prostate cancer in immigrants of south Asian origin.
Vera Donoso Cruz J.F. ’
CK34 IN THE DIAGNOSIS OF HISTOLOGICALLY OF THE PROSTATE. COMPARATIVE STUDY
C.‘, Pefias Pardo L.‘, Salem Fuster J.V.2, Vera Sempere
iLa Fe University Hospital, Department Department University Hospital,
F.Z, Jimenez
of Urology, Valencia, Spain, of Pathology, Valencia,
OF
CHEMOPREVENTION IN PATIENTS WITH NEOPLASIA
ON HIGH
PSA AND CLINICAL GRADE PROSTATIC
Joniau S.‘, Goeman L.‘, Roskams T.‘; Oyen R.;, Van Poppel H.’
‘University Hospital Leuven, Department of Urology, Leuver+ Belgium, ‘University Hospital Leuven, Department of Pathology, Leuven, Belgum, YJniverslty Hospital Leuven, Depattment of Radiology, Leuven, Belgium INTRODUCTION & OBJECTIVES: High Grade Prostatic Intraepithelial Neoplasia IH.G.P.1.N.) is eenerallv accented to be a precursor lesion of mostate cancer. A nrosoective 6. tnonth f&w-up study-of IOdpatients with H.G.P.I.N. was p&formed to investi&te ihe effects of a short-term chemoprevention scheme on P.S.A. and clinical management. MATERIAL & METHODS: In a 2-year period, 100 men were included in a prospective trial, evaluating the effects of a short term Selenium-Vitamin E-Isoflavonoids supplement in patients diagnosed with H.G.P.I.N. on &ant biopsies of the prostate. 24 patients refused further biopsies. 76 underwent a second set of biopsies at 3 months (V2) and 62 underwent a third set of biopsies at 6 months (V3). In all but four patients (23127) in whom prostate cancer was found on V2 or V3 biopsies, a radical prostatectomy was done. RESULTS: Mean age at inclusion was 62.7 years (range 43-80) and mean total P.S.A. was 5.63 n&n1 (rant 0.23-31.9). At V2. a decrease in P.S.A. from baseline was observed in 64% of p&e&. Inyhis group, prostate c&er was found in 12.2% of men. In a further 36% of patients, an increase in P.S.A. from baseline was noticed. In this group, prostate cancer was found in 29.6% of men. At the end of the study (V2+V3), cancer was found in of 35.5% (n=27) of men, H.G.P.I.N. in 39.5% (n=30), isolated L.G.P.I.N. in 14.5% (n=ll), and no P.I.N. or carcinoma in 10.5% (n=8). The risk of finding cancer throughout the whole of the study was 26.5% in the group with a P.S.A..decrease from baseline (64% of patients) and 51.9% in the group with a P.S.A..increase from baseline (34% of patients). In patients who underwent a radical prostatectomy (n=23), pathological stage ranged from foci of micro-invasive carcinoma to pT3a. Gleason scores ranged from micro-invasive carcinoma to Gleason score 8. In the V2 group (n=l3), all but one patient had organ confined cancers (1 was pT3), 53.8% had a Gleason score of 7 or more and the incidence of significant cancers (volume of 0.5ml or more) was 69.2%. In the V3 group (n=lO), all cancers were organ-confined, 90% had a Gleason score less than 7 and 60% were insignificant cancers (volume i OSml). CONCLUSIONS: In the present group of patients diagnosed with H.G.P.I.N. and on a Selenium-Vitamin E-Isoflavonoids supplement, the risk of finding prostate cancer in a 6-months follow-up period was 35.5%. Interestingly, in a large subgroup (64%), P.S.A. decl-eased under supplement therapy. In this subgroup, the overall risk of finding cancer was only 26.5% compared to 51.9% in a smaller subgroup ofpatients (36%) in whom the P.S.A. continued to rise under supplements. Thus, close P.S.A. monitoring is mandatory in patients with H.G.P.I.N. who are on supplement therapy. A Selenium-Vitamin E-Isoflavonoids supplement is probably only of interest in those patients with a P.S.A. response. Long term studies are required to further validate this observation.
‘La Fe Spain
INTRODUCTION & OBJECTIVES: Identification of basal prostatic cells (BPC) is a diagnostic clue in atypical lesions of this gland suggesting malignancy. Until now, immunohistochemical study with 34PE12 is the standard method in this situation. In recent years, a new marker for basal cells of prostate has been described: ~63. In present study we evaluate the utility of both markers in the diagnosis and classification of these lesions. MATERIAL & METHODS: We have studied 65 biopsies of prostate evaluated by one pathologist. Cases were selected due to diagnostic doubts about their malignancy (24 patients) or due to the existence of atypical lesions nearby clear adenocarcinoma areas (41 cases). All cases were reviewed by a second pathologist in a retrospective way. Further, study with both markers p63 (Neomarkers, l/100) and 34pE.12 (Dako, 11100) was performed. Finally, two pathologists evaluated the efficacy of both markers for the detection of BPC and last diagnostic category. RESULTS: P63 antibody showed a higher efficacy and resolution than 34fiEl2 in the diagnosis of these cases (> 65% of cases). Also variability in immunostaining was lower with ~63. Information reached by these two markers allowed to establish a diagnosis in 75 % of cases studied. Initial estimation of tumour volume was increased in 30 % of cases by using these markers, offering p63 the highest increase (75 % of total). CONCLUSIONS: P63 is a useful marker of BPC in comparison with CK34SE12. It offers a better diagnosis of histologically atypical prostatic lesions and a more precise evaluation of the tumour volume in prostatic samples.
259 THE EFFECT MANAGEMENT INTRAEPITHELIAL
OF
260 ISOLATED MONOAND PLURI-FOCAL HIGH GRADE INTRAEPITHELIAL NEOPLASIA (HGPIN) ON INITIAL PROSTATE NEEDLE BIOPSIES: FACTORS PREDICTING DETECTION ON EXTENDED RE-BIOPSY Roscieno M.‘, Scattoni F.l, Rigatti P.’
‘University
V.‘, Freschi
“Vita-Salute”
M.*, Pasta A.‘, Colombo
Scientific
Institute
Milan, Italy, Wniversity “Vita-Salute” of Pathology, Milan, Italy INTRODUCTION & OBJECTIVES: via extended repeat prostate biopsies HGPIN diagnosis.
MATERIAL underwent
& METHODS: lo-12
systematic
From
PROSTATIC EXTENDED CANCER
R.‘, Bertini
R.‘. Montorsi
H. San Raffaele, Department of Urology, Institute H. San Raffaele, Department
Scientific
To evaluate factors predicting in patients with initial isolated
January,
TRUS-guided
1995, to June, 2002, biopsies.
At
least
five
cancer detection mono/pluri-focal
2,314 patients biopsies
were
performed in each lobe: in addition to sextant biopsies, cores were taken both from the far lateral region of the gland and the transition zone, depending on gland vo!ume (10 cores for prostate < 50 gr.; 12 cores in prostate ‘50 gr.). Forty-seven patients with initial HGPIN diagnosis were re-biopsied using the same technique (mean repeat biopsy cores: 11.5) after a median follow-up time of 11.4 months (range 3-24 months).
RESULTS: Cancer was detected on second biopsy in 21 patients (44.6%). Cancer detection was significantly higher in patients with pluri-focal HGPIN when compared to those with mono-focal HGPIN (70% vs. 10%; respectively) (p
more than 6 months after a first biopsy set (65%) when compared to patients before 6 months or less (25%) (~‘0.01; mean follow-up time 15.5 and 3.8
months, respectively). In a univariate analysis the mean PSAD (&SD) was statistically different in the two groups: 0.11 ho.05 and 0.25 hO.04, respectively; (p=O.O2). Multivariate analysis showed that Prostate Specific Antigen (PSA), PSA Density, Digital Rectal Examination and Transrectal Ultrasound findings were not significant predictors
of prostate cancer, while HGPIN multi-focality and re-biopsy h-month follow-up interval) were independent prognostic prostatectomy
(14 patients),
patient groups re-biopsied CONCLUSIONS: /pluri-focal HGPIN
there were no differences before or after 6 months.
Following
lo-to-12
diagnoses
had an overall
biopsies,
time lapse (more than a factors. After radical
at the pathological
patients
with
cancer detection
initial,
stage between
isolated
mono-
rate of 45% on repeat
extended biopsies. HGPIN’s pluri-focality on first biopsy and re-biopsy time interval are independent predictive factors in cancer detection. A 12-to-18 month re-biopsy follow-up should permit a significantly higher cancer detection rate; with no apparent likelihood of clinical cancer progression.
European
Urology
Supplements
3 (2004)
No. 2, pp. 67