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347 PREVALENCE OF INFLAMMATION AND PROSTATE CARCINOMA IN ASIAN AND CAUCASIAN MEN: AN AUTOPSY STUDY
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THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
vs. 46.6 vs. 43.3%, p⫽0.002), all the other pathological characteristics remained stable. Specifically, extracapsular extension, seminal vesicle and lymph node invasion rates were 20 vs. 22.3 vs. 26% (p⫽0.2), 38.6 vs. 32.8 vs. 37.5% (p⫽0.2) and 30.7 vs. 29.4 vs. 37.4% (p⫽0.06) in the three tertiles, respectively. The prevalence of patients defined as high risk according to a single criterion (PSA⬎20 ng/ml or cT3 or biopsy Gleason 8-10) was 72.0 vs. 71.1 vs. 73.3% in the three tertiles, respectively (p⫽0.2). Similarly, the prevalence of patients defined as high risk for the simultaneous presence of two or three criteria remained stable (all p⬎0.2). CONCLUSIONS: Despite the trend towards early diagnosis, characteristics of high risk PCa patients did not change over time. Particularly, pathological characteristics and presence of more aggressive PCa variants remained virtually identical over the last 15 years.Increase of higher Gleason grade might be due to improved pathological PCa staging.
Source of Funding: Glaxo Smith Kline. Prostate Cancer Research Foundation of Canada
Source of Funding: None
346 DO ASIAN AND CAUCASIAN MEN DEVELOP HIGH GRADE (GLEASON &[GE]7) PROSTATE CANCER AT THE SAME AGE? AN AUTOPSY STUDY Alexandre R Zlotta*, Toronto, Canada; Shin Egawa, Tokyo, Japan; Dmitry Pushkar, Alexander Govorov, Moscow, Russian Federation; Takahiro Kimura, Masahito Kido, Hiroyuki Takahashi, Tokyo, Japan; Cynthia Kuk, Toronto, Canada; Marta Kovylina, Moscow, Russian Federation; Najla Aldaoud, Neil E Fleshner, Antonio Finelli, Laurence Klotz, Jenna Sykes, Gina Lockwood, Theodorus H van der Kwast, Toronto, Canada INTRODUCTION AND OBJECTIVES: We have previously demonstrated that PCa prevalence is similar between Russian Caucasians and Japanese Asian men. We had chosen a specific Caucasian population in Russia with low penetrance of PSA screening. Autopsy data in North America and Western Europe would have been heavily contaminated due to opportunistic PSA screening. Screening in Japan is also uncommon. Here our aim was to compare the prevalence of Gleason ⱖ7 PCa on autopsy in Caucasian and Asian men. METHODS: 320 prostate glands were prospectively collected during autopsy from men who died from causes other than PCa in Moscow (Russia n⫽220)-(CAU) and Tokyo (Japan n⫽100)-(ASI). The same harvesting methodology was followed in both sites. Prostates were removed en-block with the seminal vesicles within 24 hours of death and analyzed in toto (perpendicular sections at 4 mm intervals) by an experienced uro-pathologist. We compared across the ASI and CAU populations, the prevalence of GSⱖ7 PCa over the various age groups. RESULTS: Overall, 37 out of 117 tumors (31.6%) were GSⱖ7, with a significantly higher proportion in ASI men (51.4%) compared to CAU men (23.2%, p⫽0.003). Fig 1 illustrates the prevalence of GSⱖ7 PCa in ASI and CAU men according to age. Compared to CAU, in our autopsy cohort, a higher prevalence of GSⱖ7 PCa was observed at a later age among ASI with a steeper increase in prevalence by the decade. Breaking down GS7 into (3⫹4) or (4⫹3), among 14 GS7 in ASI, 13 were 3⫹4 and 1 was 4⫹3. Among 16 CAU with GS7, 10 and 6 were 3⫹4 and 4⫹3, respectively, (p⫽0.086). Limitations include small population size and the absence of Caucasian men aged 80⫹. CONCLUSIONS: A higher proportion of autopsy detected PCa in Asian men is GSⱖ7 compared to Caucasians. Asian men seem to have a higher prevalence of GSⱖ7 PCa at a later decade in life compared to Caucasian men. A hypothesis is that in Asian men, the grade progression is much faster than in Caucasian men. The alternative hypothesis would be a de novo origin of GSⱖ7 instead of grade progression.
347 PREVALENCE OF INFLAMMATION AND PROSTATE CARCINOMA IN ASIAN AND CAUCASIAN MEN: AN AUTOPSY STUDY Alexandre R Zlotta*, Toronto, Canada; Shin Egawa, Tokyo, Japan; Dmitry Pushkar, Alexander Govorov, Moscow, Russian Federation; Takahiro Kimura, Masahito Kido, Hiroyuki Takahashi, Tokyo, Japan; Cynthia Kuk, Toronto, Canada; Marta Kovylina, Moscow, Russian Federation; Najla Aldaoud, Neil E Fleshner, Antonio Finelli, Laurence Klotz, Jenna Sykes, Gina Lockwood, Theodorus H van der Kwast, Toronto, Canada INTRODUCTION AND OBJECTIVES: Chronic inflammation has been known to contribute to several forms of cancer. Recent but controversial data have suggested that prostatic inflammation might also be involved in the pathogenesis of prostate cancer (PCa). In the REDUCE trial, chronic histologic inflammation was found in 78% of men, reflecting its ubiquitous nature whereas acute inflammation was found in 16.5% of the study population. Few studies have analyzed the relationship between inflammation (acute and chronic) and PCa on autopsy specimens and none compared Asian (ASI) to Caucasian (CAU) men. The primary goal of this study was to investigate the prevalence of inflammation among PCa in ASI and CAU men in autopsy specimens. METHODS: Prostate glands were prospectively obtained during autopsy from men who died from other causes than PCa in Moscow (Russia)-(CAU) and Tokyo (Japan)-(ASI). Prostates were removed en-block within 24 hours of death, immediately injected with buffered formalin (pH 7.3), placed in buffered formalin for two to three days at room temperature and analyzed in toto. Identification of PCa, its Gleason score (GS) and, acute inflammation (grade 0-3) and chronic inflammation (grade 0-3) was assessed by an experienced uro-pathologist. We compared and correlated across the ASI and CAU populations the presence or absence of acute or chronic inflammation, their degree of severity and the presence of PCa and GS. We used the Cochran Armitage test for trend, Spearman correlation, the chi-square test and Wilcoxon tests for statistical analyses. RESULTS: 320 prostates were collected, 220 from CAU and 100 from ASI men. Mean age was 62.5 and 68.5 years in CAU and ASI men, respectively (p⬍0.001). Chronic inflammation was found in 72.0 and 75.9% of ASI and CAU men, respectively (no significant difference). Chronic inflammation was strongly associated with older age and acute inflammation (all p⬍0.001). There was no evidence of an association between acute inflammation and PCa or ethnicity. We observed a significant association between GS7 and chronic inflammation (p⫽0.015). CONCLUSIONS: Chronic inflammation is associated with PCa on autopsy both in Asian and Caucasian men and interestingly, with cancers presenting aggressive features (GSⱖ7). No evidence of a causal relation can be proven at this stage but this topic clearly deserves scrutiny and additional research. Source of Funding: Pierre Fabre Medicament Glaxo Smith Kline Prostate Cancer Research Foundation of Canada
THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
vs. 46.6 vs. 43.3%, p⫽0.002), all the other pathological characteristics remained stable. Specifically, extracapsular extension, seminal vesicle and lymph node invasion rates were 20 vs. 22.3 vs. 26% (p⫽0.2), 38.6 vs. 32.8 vs. 37.5% (p⫽0.2) and 30.7 vs. 29.4 vs. 37.4% (p⫽0.06) in the three tertiles, respectively. The prevalence of patients defined as high risk according to a single criterion (PSA⬎20 ng/ml or cT3 or biopsy Gleason 8-10) was 72.0 vs. 71.1 vs. 73.3% in the three tertiles, respectively (p⫽0.2). Similarly, the prevalence of patients defined as high risk for the simultaneous presence of two or three criteria remained stable (all p⬎0.2). CONCLUSIONS: Despite the trend towards early diagnosis, characteristics of high risk PCa patients did not change over time. Particularly, pathological characteristics and presence of more aggressive PCa variants remained virtually identical over the last 15 years.Increase of higher Gleason grade might be due to improved pathological PCa staging.
Source of Funding: Glaxo Smith Kline. Prostate Cancer Research Foundation of Canada
Source of Funding: None
346 DO ASIAN AND CAUCASIAN MEN DEVELOP HIGH GRADE (GLEASON &[GE]7) PROSTATE CANCER AT THE SAME AGE? AN AUTOPSY STUDY Alexandre R Zlotta*, Toronto, Canada; Shin Egawa, Tokyo, Japan; Dmitry Pushkar, Alexander Govorov, Moscow, Russian Federation; Takahiro Kimura, Masahito Kido, Hiroyuki Takahashi, Tokyo, Japan; Cynthia Kuk, Toronto, Canada; Marta Kovylina, Moscow, Russian Federation; Najla Aldaoud, Neil E Fleshner, Antonio Finelli, Laurence Klotz, Jenna Sykes, Gina Lockwood, Theodorus H van der Kwast, Toronto, Canada INTRODUCTION AND OBJECTIVES: We have previously demonstrated that PCa prevalence is similar between Russian Caucasians and Japanese Asian men. We had chosen a specific Caucasian population in Russia with low penetrance of PSA screening. Autopsy data in North America and Western Europe would have been heavily contaminated due to opportunistic PSA screening. Screening in Japan is also uncommon. Here our aim was to compare the prevalence of Gleason ⱖ7 PCa on autopsy in Caucasian and Asian men. METHODS: 320 prostate glands were prospectively collected during autopsy from men who died from causes other than PCa in Moscow (Russia n⫽220)-(CAU) and Tokyo (Japan n⫽100)-(ASI). The same harvesting methodology was followed in both sites. Prostates were removed en-block with the seminal vesicles within 24 hours of death and analyzed in toto (perpendicular sections at 4 mm intervals) by an experienced uro-pathologist. We compared across the ASI and CAU populations, the prevalence of GSⱖ7 PCa over the various age groups. RESULTS: Overall, 37 out of 117 tumors (31.6%) were GSⱖ7, with a significantly higher proportion in ASI men (51.4%) compared to CAU men (23.2%, p⫽0.003). Fig 1 illustrates the prevalence of GSⱖ7 PCa in ASI and CAU men according to age. Compared to CAU, in our autopsy cohort, a higher prevalence of GSⱖ7 PCa was observed at a later age among ASI with a steeper increase in prevalence by the decade. Breaking down GS7 into (3⫹4) or (4⫹3), among 14 GS7 in ASI, 13 were 3⫹4 and 1 was 4⫹3. Among 16 CAU with GS7, 10 and 6 were 3⫹4 and 4⫹3, respectively, (p⫽0.086). Limitations include small population size and the absence of Caucasian men aged 80⫹. CONCLUSIONS: A higher proportion of autopsy detected PCa in Asian men is GSⱖ7 compared to Caucasians. Asian men seem to have a higher prevalence of GSⱖ7 PCa at a later decade in life compared to Caucasian men. A hypothesis is that in Asian men, the grade progression is much faster than in Caucasian men. The alternative hypothesis would be a de novo origin of GSⱖ7 instead of grade progression.
347 PREVALENCE OF INFLAMMATION AND PROSTATE CARCINOMA IN ASIAN AND CAUCASIAN MEN: AN AUTOPSY STUDY Alexandre R Zlotta*, Toronto, Canada; Shin Egawa, Tokyo, Japan; Dmitry Pushkar, Alexander Govorov, Moscow, Russian Federation; Takahiro Kimura, Masahito Kido, Hiroyuki Takahashi, Tokyo, Japan; Cynthia Kuk, Toronto, Canada; Marta Kovylina, Moscow, Russian Federation; Najla Aldaoud, Neil E Fleshner, Antonio Finelli, Laurence Klotz, Jenna Sykes, Gina Lockwood, Theodorus H van der Kwast, Toronto, Canada INTRODUCTION AND OBJECTIVES: Chronic inflammation has been known to contribute to several forms of cancer. Recent but controversial data have suggested that prostatic inflammation might also be involved in the pathogenesis of prostate cancer (PCa). In the REDUCE trial, chronic histologic inflammation was found in 78% of men, reflecting its ubiquitous nature whereas acute inflammation was found in 16.5% of the study population. Few studies have analyzed the relationship between inflammation (acute and chronic) and PCa on autopsy specimens and none compared Asian (ASI) to Caucasian (CAU) men. The primary goal of this study was to investigate the prevalence of inflammation among PCa in ASI and CAU men in autopsy specimens. METHODS: Prostate glands were prospectively obtained during autopsy from men who died from other causes than PCa in Moscow (Russia)-(CAU) and Tokyo (Japan)-(ASI). Prostates were removed en-block within 24 hours of death, immediately injected with buffered formalin (pH 7.3), placed in buffered formalin for two to three days at room temperature and analyzed in toto. Identification of PCa, its Gleason score (GS) and, acute inflammation (grade 0-3) and chronic inflammation (grade 0-3) was assessed by an experienced uro-pathologist. We compared and correlated across the ASI and CAU populations the presence or absence of acute or chronic inflammation, their degree of severity and the presence of PCa and GS. We used the Cochran Armitage test for trend, Spearman correlation, the chi-square test and Wilcoxon tests for statistical analyses. RESULTS: 320 prostates were collected, 220 from CAU and 100 from ASI men. Mean age was 62.5 and 68.5 years in CAU and ASI men, respectively (p⬍0.001). Chronic inflammation was found in 72.0 and 75.9% of ASI and CAU men, respectively (no significant difference). Chronic inflammation was strongly associated with older age and acute inflammation (all p⬍0.001). There was no evidence of an association between acute inflammation and PCa or ethnicity. We observed a significant association between GS7 and chronic inflammation (p⫽0.015). CONCLUSIONS: Chronic inflammation is associated with PCa on autopsy both in Asian and Caucasian men and interestingly, with cancers presenting aggressive features (GSⱖ7). No evidence of a causal relation can be proven at this stage but this topic clearly deserves scrutiny and additional research. Source of Funding: Pierre Fabre Medicament Glaxo Smith Kline Prostate Cancer Research Foundation of Canada