Biologic differences between peripheral and transition zone prostate cancer

Abstract

Background Prostate cancer arises in the transition zone (TZ) in approximately 20-25% of cases. Modern biopsy and surveillance protocols, and advances in prostate cancer imaging, have renewed interest in TZ prostate cancers. We compared TZ and PZ prostate cancer to determine if cancer location is independently associated with better outcomes. Methods We evaluated an expanded cohort of 1534 men who underwent radical prostatectomy between 1983 and 2003 with updated long-term clinical follow-up. Regression models were used to compare the volume of high-grade (Gleason 4 or 5) cancer and total cancer volume by location. Uni- and multi-variable logistic regression models tested the associations between cancer location and adverse pathologic features. Multivariable proportional hazard models were fit to examine cancer recurrence. Results Patients with TZ cancer presented with higher pre-operative serum PSA values (11.07 versus 7.86 ng/mL) and larger total cancer volume (7.1 versus 3.8 cc). Patients with TZ cancer had decreased odds of seminal vesicle invasion (OR 0.08, 95%CI 0.03, 0.21), extra-capsular extension (OR 0.56, 95%CI 0.35,0.92), and lymphovascular invasion (OR 0.48, 95%CI 0.27, 0.87) in multivariable models. TZ cancers were independently associated with decreased hazard of tumor recurrence (HR 0.62, 95%CI 0.43, 0.90). Conclusions TZ cancer prostate is associated with favorable pathologic features and better recurrence-free survival despite being diagnosed with larger cancers and higher PSA values. Tumor location should be taken into account when stratifying patient risk before and after prostatectomy, particularly with the evolving role of imaging in prostate cancer management.

LINE-1 methylation status in prostate cancer and non-neoplastic tissue adjacent to tumor in association with mortality

“…This is consistent with data suggesting that tumors of the transition zone, which are 20-25% of all prostate tumors, show a specific morphological, 33 clinical, 34,35 biological, 36 and molecular [37][38][39] behavior. Furthermore, findings of the current study are similar to those of a recent study on tumor-negative prostate samplings, in which we found higher LINE-1 methylation levels in TURPs than in biopsies.…”

The Androgen Receptor in Prostate Cancer: Effect of Structure, Ligands and Spliced Variants on Therapy

“…Luminal, basal, and neuroendocrine cells constitute the normal prostate epithelia in a roughly 60:40:1 ratio [ 2 ]. Prostate cancer (PCa) develops most often in the PZ, less often in the TZ, and rarely in the CZ [ 3 , 4 ]. Upon development of PCa, the ratio of luminal to basal percentages are greatly altered, with the luminal cells constituting >99% of the tumor [ 2 ] ( Figure 1 ).…”

Computer-aided Detection of Prostate Cancer with MRI

“…The prostate also has four anatomic zones: the transition zone (TZ), which contains 5% of the glandular tissue and accounts for around 25% of PCa; the central zone (CZ), which contains 20% of the glandular tissue and accounts for around 5% of PCa; the peripheral zone (PZ), which contains 70–80% of the glandular tissue and accounts for about 70% of PCa; and the non-glandular anterior fibromuscular stroma. Accurate localization of PCa within the TZ or the PZ is extremely important as TZ prostate cancer is associated with favorable pathologic features and better recurrence-free survival [2]. …”