Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(2):198-202 | DOI: 10.5507/bp.2020.054

Do not underestimate anterior prostate cancer

Sarka Kudlackovaa, Daniela Kurfurstovab, Milan Krala, Frantisek Hruskaa, Ales Vidlara, Vladimir Student
a Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
b Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Aims: With the introduction of magnetic resonance imaging in the diagnosis of prostate cancer and its use in targeted prostate biopsy, an increased incidence of anterior-predominant prostate cancer (APC) has been observed.

Methods: We enrolled 200 patients who underwent radical prostatectomy at our department between 12/2017 and 04/2019. We evaluated tumour location in the individual segments of the prostate, index tumour location and volume, and compared the postoperative stage, Gleason score, grade group (GG), and the presence of extraprostatic extension (EPE) in APC and posterior prostate cancer (PPC). We assessed the rate of MRI scans prior to prostate surgery as well as the influence of family history and PSA on the presence of APC.

Results: We found a significantly higher rate of anterior tumours than previously reported (37%) and confirmed that these tumours are diagnosed with a significantly larger index tumour volume (P=0.003). We also showed that a mere 6.76% of APCs were low-risk tumours not requiring radical treatment. Furthermore, anterior tumours were found significantly more often (P=0.001) in patients who underwent preoperative MRI. No differences were observed between PSA values, family history, presence of EPE, or locally advanced disease in APC vs. PPC.

Conclusions: The frequency of anterior tumours is higher than previously thought, and they include tumours requiring radical treatment. When these tumours are neglected, it may lead to patient undertreatment with impact on their life prognosis. Thus, we consider the use of MRI-targeted prostate biopsy to be a necessity both for ruling out APC in the case of repeatedly negative prostate biopsies and, in particular, before patient inclusion in active surveillance.

Keywords: anterior prostate cancer, prostate biopsy, MRI, targeted biopsy

Received: August 9, 2020; Revised: November 6, 2020; Accepted: November 10, 2020; Prepublished online: November 26, 2020; Published: June 10, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Kudlackova, S., Kurfurstova, D., Kral, M., Hruska, F., Vidlar, A., & Student, V. (2021). Do not underestimate anterior prostate cancer. Biomedical papers, 165(2), 198-202. doi: 10.5507/bp.2020.054
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. McNeal JE, Cancer volume and site of origin of adenocarcinoma in the prostate: relationship to local and distant spread. Hum Pathol 1992;23:258-66. Go to original source... Go to PubMed...
    2. McNeal JE, Haillot O. Patterns of spread of adenocarcinoma in the prostate as related to cancer volume. Prostate 2001;49:48-57. Go to original source... Go to PubMed...
    3. McNeal JE, Redwine EA, Freiha FS, Stamey TA. Zonal distribution of prostatic adenocarcinoma: correlation with histologic pattern and direction of spread. Am J Surg Pathol 1988;12(12):897-906. Go to original source... Go to PubMed...
    4. Al-Ahmadie HA, Tickoo SK, Olgac S, Gopalan A, Scardino PT, Reuter VE, Fine SW. Anterior-predominant prostatic tumors: zone of origin and pathologic outcomes at radical prostatectomy. Am J Surg Pathol 2008;32:229-35. Go to original source... Go to PubMed...
    5. Stamey TA, Donaldson AN, Yemoto CE, McNeal JE, Sözen S, Gill H. Histological and clinical findings in 896 consecutive prostates treated only with radical retropubic prostatectomy: epidemiologic significance of annual ganges. J Urol 1998;160:2412-17. Go to original source... Go to PubMed...
    6. Liu IJ, Macy M, Lai YH, Terris MK. Critical evaluation of the current indications for transition zone biopsies. Urology 2001;57:1117-20. Go to original source... Go to PubMed...
    7. Bott SR, Young MP, Kellett MJ, Parkinson MC. Anterior prostate cancer: is it more difficult to diagnose? BJU Int 2002;89:886-89. Go to original source... Go to PubMed...
    8. Koppie TM, Bianco FJ, Jr, Kuroiwa K, Reuter VE, Guillonneau B, Eastham JA, Scardino PT. The clinical features of anterior prostate cancers. BJU international 2006;98(6):1167-71. Go to original source... Go to PubMed...
    9. Schouten MG, van der Leest M, Pokorny M, Hoogenboom M, Barentz JO, Thompson LC, Fütterer JJ. Why and where do we miss significant prostate cancer. Eur Urol 2017;71:896-903. Go to original source... Go to PubMed...
    10. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2016;40:244-52. Go to original source... Go to PubMed...
    11. D'Amico AV, Whittington R, Malkowicz SB, Cote M, Schultz D, Chen MH, Tomaszewski JE, Renshaw AA, Wein A, Richie JP. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002;95(2):281-86. Go to original source... Go to PubMed...
    12. Eichler K, Hempel S, Wilby J, Myers L, Bachmann LM, Kleijnen J. Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review. J Urol 2006;175:1605-12. Go to original source... Go to PubMed...
    13. Chen ME, Johnston DA, Tang K, Babaian RJ, Troncoso P. Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 2000;89(8):1800-9. Go to original source...
    14. Meng MV, Franks JH, Presti JC, Jr, Shinohara K. The utility of apical anterior horn biopsies in prostate cancer detection. Urol Oncol 2003;21:361-65. Go to original source... Go to PubMed...
    15. Stewart ChS, Leibovich BC, Weaver AL, Lieber MM Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol 2001;166,86-92. Go to original source... Go to PubMed...
    16. Montie JE, Wood DP, Jr, Pontes JE, Boyett JM, Levin HS. Adenocarcinoma of the prostate in cystoprostatectomy specimens removed for bladder cancer. Cancer 1989;63:381-85. Go to original source... Go to PubMed...
    17. Kabalin JN, McNeal JE, Price HM, Freiha FS, Stamey TA. Unsuspected adenocarcinoma of the prostate in patients undergoing cystoprostatectomy for other causes: incidence, histology and morphometric observations. J Urol 1989;141:1091-94. Go to original source... Go to PubMed...
    18. Teloken PE, Li J, Woods CG, Cohen RJ. The impact of prostate cancer zonal origin on pathological parameters at radical prostatectomy and subsequent biochemical failure. J Urol 2017;198(6):1316-23. Go to original source... Go to PubMed...
    19. Cheng L, Jones TD, Pan CX, Barbarin A, Eble JN, Koch MO. Anatomic distribution and pathologic characterization of small-volume prostate cancer (
    20. de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 2016;70:233-45. Go to original source... Go to PubMed...
    21. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 2015;68:438-50. Go to original source... Go to PubMed...
    22. Glass AS, Pugashetti NB, Dall'Era MA, Evans CP, Yap SA. Utility of anterior zone biopsy in men enrolled in active surveillance for prostate cancer. Clin Genitourin Cancer doi: 10.1016/j.clgc.2017.07.007 Epub 2017 July 14 Go to original source... Go to PubMed...
    23. Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, Carter HB. et Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol 2015;33:3379-85. Go to original source... Go to PubMed...
    24. Lawrentschuk N, Haider MA, Daljeet N, Evans A, Toi A, Finelli A, Trachtenberg J, Zlotta A, Fleshner N. Prostatic evasive anterior tumours: the role of magnetic resonance imaging. BJU Int 2010;105:1231-36. Go to original source... Go to PubMed...
    25. Hoeks CM, Barentsz JO, Hambrock T, Yakar D, Somford DM, Heijmink SW, Scheenen TW, Vos PC, Huisman H, van Oort IM, Witjes JA, Heerschap A, Fütterer JJ. Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 2011;261:46-66. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content