MP48-17 ANTERIOR PROSTATE CANCER: CLINICOPATHOLOGIC CHARACTERIZATION WITH BIOPSY CORRELATION (2015)

You have accessJournal of UrologyProstate Cancer: Detection and Screening I1 Apr 2015MP48-17 ANTERIOR PROSTATE CANCER: CLINICOPATHOLOGIC CHARACTERIZATION WITH BIOPSY CORRELATION Martin Magers, Tianyu Zhan, Aaron Udager, Brent Hollenbeck, John Wei, David Miller, Jeffrey Montgomery, Javed Siddiqui, Felix Feng, Daniel Hamstra, Alon Weizer, Todd Morgan, Arul Chinnaiyan, Ganesh Palapattu, Hui Jiang, and Rohit Mehra Martin MagersMartin Magers More articles by this author , Tianyu ZhanTianyu Zhan More articles by this author , Aaron UdagerAaron Udager More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , John WeiJohn Wei More articles by this author , David MillerDavid Miller More articles by this author , Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Javed SiddiquiJaved Siddiqui More articles by this author , Felix FengFelix Feng More articles by this author , Daniel HamstraDaniel Hamstra More articles by this author , Alon WeizerAlon Weizer More articles by this author , Todd MorganTodd Morgan More articles by this author , Arul ChinnaiyanArul Chinnaiyan More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Hui JiangHui Jiang More articles by this author , and Rohit MehraRohit Mehra More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1691AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anterior prostate cancer (APC) is an incompletely understood entity which may be difficult to sample via transrectal biopsy. Seemingly favorable biopsy results may belie the potential aggressiveness of these tumors. Here, we attempt to characterize APC by reviewing our experience at the University of Michigan Health System and correlate our findings with previous biopsy data from these patients. METHODS All radical prostatectomy (RP) cases with whole mount sections from 1/2012 to 5/2014 were assessed for APC [bulk of index tumor (largest size) anterior to the midpoint of the urethra]. Clinicopathologic parameters of the anterior index tumor and other tumor foci were assessed and compared to non-APC in the same cohort. Previous biopsy information was correlated with RP. RESULTS Of the 467 patients in this cohort, 72 (15%) had APC: 50 in the anterior peripheral zone (APZ, 69%); 10 in the transitional zone (TZ, 14%); and 12 involving both the APZ and TZ (17%). 25 APC were single tumors (35%), and the rest were multifocal. Clinicopathologic information was available for 72 APC patients and 308 non-APC patients and is compared in Table 1. 15% of APC patients demonstrated a primary Gleason pattern 4 or higher, and 21% had extraprostatic extension (EPE) present. None of the APC, including the high-grade (GS>7) cases, demonstrated seminal vesicle invasion (SVI). 10 APC had a positive surgical margin (13%), most commonly at the apex or base. 56 APC were preceded by an extended biopsy (78%), while 2 APC had only sextant biopsy (3%) and 14 APC were identified after a combination of extended and perineal saturation biopsies (19%). APC was present on significantly fewer cores and with less tumor involvement of the core. APC patients frequently (54%) had a higher GS or novel Gleason pattern 5 at RP than at biopsy. Distribution of preoperative serum PSA levels was similar between APC and non-APC patients. CONCLUSIONS APC demonstrate distinct clinicopathologic features (including absence of SVI) and are frequently under-graded and minimally sampled at the time of biopsy. These unique characteristics may have a clinical impact on detection (i.e., need for saturation biopsy) and suitability for inclusion in active surveillance protocols. Future long-term studies are needed to determine the outcome of patients with APC. Table 1. APC (n=72) non-APC (n=308) Gleason Score: 3+3=6 19.4% 8.2% 3+4=7 63.9% 47.7% 4+3=7 9.7% 25.3% =8-10 5.6% 17.5% Size (mean, cm) 1.9 1.9 Weight (mean, g) 49.8 50.0 Patient age (mean, years) 61.5 61.9 Preoperative serum PSA (number of cases): < or = 4 14 (23%) 54 (19%) 4-7 20 (33%) 112 (40%) >7 28 (45%) 114 (41%) Pathologic stage: pT2 79.2% 64.9% pT3a (EPE present) 20.8% 26.6% pT3b (SVI present) 0% 8.4% Positive surgical margin 13.4% 19.5% Location of positive margin (number of cases at each location): Anterior 2 2 Right posterolateral 0 17 Left posterolateral 0 20 Apical 4 13 Basal 7 15 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e600-e601 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Magers More articles by this author Tianyu Zhan More articles by this author Aaron Udager More articles by this author Brent Hollenbeck More articles by this author John Wei More articles by this author David Miller More articles by this author Jeffrey Montgomery More articles by this author Javed Siddiqui More articles by this author Felix Feng More articles by this author Daniel Hamstra More articles by this author Alon Weizer More articles by this author Todd Morgan More articles by this author Arul Chinnaiyan More articles by this author Ganesh Palapattu More articles by this author Hui Jiang More articles by this author Rohit Mehra More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...