Characteristics of Prostatic Adenocarcinoma in a Contemporary Australian Radical Prostatectomy Series from a Community without Population-Based PSA Screening
Hemamali Samaratunga, John Yaxley, Joanna Perry-Keene, Michael Adamson, Brett Delahunt. Aquesta Pathology, Brisbane, Queensland, Australia; Royal Brisbane Hospital, Brisbane, Queensland, Australia; Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
Background: With PSA testing, up to 30% of small potentially clinically insignificant cancers are detected. Possible overtreatment is an issue with some of these cases. The current study was performed to characterize prostate cancer in men undergoing radical prostatectomy in a community without population based PSA screening.
Design: Clinical and pathological data of 2700 patients who had a radical prostatectomy (RP) between 2008 and 2012 were analysed. Specimens were entirely embedded and evaluated by routine haematoxylin and eosin staining. Tumours were graded using the ISUP modified Gleason grading system and staged according to the ISUP RP staging system. Tumors were considered potentially clinically insignificant if the tumor volume was <0.5 mL and Gleason score <7.
Results: The mean age was 61.4 years (range 32-79) and the mean pre-operative PSA, 19.2ng/mL (range 0.4 – 69). Indications for PSA testing included an abnormal digital rectal examination, family history of prostate cancer, obstructive urinary symptoms, community awareness or general practitioner initiation. Potentially clinically insignificant tumors were found in 129 (4.7%) patients. Of 2571 significant cancers 2383 (88%) had a final Gleason score of 7 or greater, 43% had extraprostatic extension, 640 (23%) had a tumour volume of greater than 3 mL and 341 (12.6%) had surgical margin positivity. Seminal vesical involvement was found in 156 (5.8%) cases. Of 646 patients who had a lymphadenectomy, 29 (4.49%) had lymph node metastases.205 (7.5%) patients were aged ≤50 (mean age 47 years) of whom 188 (91%) had significant cancer.
Conclusions: The vast majority of prostate cancers in populations without PSA screening are significant with a high proportion of cases showing high stage disease, seminal vesicle involvement and lymph node metastasis. Absence of population–based PSA screening appears to lead to a very high risk of prostate cancer being advanced at presentation. Selective PSA screening in men with minimum co-morbidities and a life expectancy of >15 years will lead to earlier stage disease and potentially improve long term local control and cancer free survival.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 154, Monday Afternoon