Extensive Multifocal Prostatic Adenocarcinomas (Greater Than 20) in Radical Prostatectomy Specimens of Young Men
B Furusato, P Parker, T Nydam, K Rice, S Srivastava, S Brassell, DG McLeod, IA Sesterhenn. Armed Forces Institute of Pathology, Washington, DC; Walter Reed Army Medical Center, Washington, DC; Uniformed Services University of the Health Sciences, Bethesda, MD
Background: Although the majority of prostatectomy specimens contain 3 to 4 tumors on average, it is rare to encounter greater than 20 tumors in prostatectomy specimens. The aim of this study is to characterize patients in the latter group.
Design: Radical prostatectomy specimens of 1400 consecutive patients obtained from a single institution between 1993 and 2008 were analyzed retrospectively. For each specimen, the entire prostate was sectioned and embedded as whole-mounts. Each tumor was circled and characterized separately. The presence of prostatic intraepithelial neoplasia, atypical glands, atrophy etc. were recorded. Biochemical recurrence was defined as two consecutive values of serum PSA levels ≥ 0.2 ng/mL.
Results: Among the 1400 consecutive radical prostatectomy specimens, 5 patients (0.36%) had more than 20 tumors. The median age was 42 years, and the median time of follow-up was 52 months. In 4 patients all tumors were well differentiated corresponding to a Gleason score of 6 (3+3). In one case, one of the tumors had a Gleason score of 7 (3+4, well and poorly differentiated). A number of tumors clustered in a specific region suggesting confluence to a single tumor and were measured as a single tumor. The median total tumor volume was 1.2 cc; all tumors were organ confined, surgical margin negative. Most of the tumors were located in the peripheral zone of the mid and apical thirds and were associated with prostatic intraepithelial neoplasia. In all of the patients, atypical glands were also seen. The median preoperative PSA was 2.8 ng/ml. To date, none of the patients has exhibited PSA recurrence.
Conclusions: The large number of individual microscopic tumors and the focal confluence may indicate an early stage in the development of carcinoma and could explain the heterogeneity of a large tumor. The tumor with 40% poorly differentiated component did not cause PSA recurrence at this point.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 1:00 PM
Poster Session II # 130, Monday Afternoon