Significance of the craniocaudal distribution of cancer in radical prostatectomy specimens

Abstract

Objectives:To examine the differences in the distribution of prostate cancer (PCa) in the craniocaudal dimension and their potential significance. Methods: We studied 1253 patients with clinically localized PCa treated with radical prostatectomy (RP) from 1983 to 2000. We analyzed the clinicopathological features according to the craniocaudal distribution (apex, mid , base) of the largest cancer focus. Results: Of these patients, 456 (36%) had the largest cancer focus in the apex, 728 (58%) in the mid , and 69 (6%) in the base. The cancers in the apex were less invasive than those in the mid or base, as evidenced by the lower frequency of extracapsular extension (27% vs 43%, 52%, respectively) and/or seminal vesicle involvement (5% vs 13%, 20%, respectively). The frequency of the largest cancer focus in the apex has increased significantly over time, from 26% before 1995 to 46% after 1995 (P < 0.001). Serum prostate specific antigen non-progression rate at 10 years for patients with a cancer at the apex was 83%, which was better than 76% and 77% of patients with a cancer at the mid or base (P = 0.029, P = 0.14, respectively). Conclusion:The cancers dominant at the apex are increasing over time and represent half of the patients treated by RP in recent years. These cancers tend to be less aggressive compared to those in the mid or base of the prostate. This knowledge may be useful in understanding the biology of and maximizing the detection of PCa

Analysis of Preoperative Detection for Apex Prostate Cancer by Transrectal Biopsy

“…The study population was small, a fact that might influence the results. On the other hand, the location of prostate cancer in Japanese men differed from that seen in the United States [5, 6]. These findings suggest there may be some racial differences regarding PCA localization.…”

“…Detection of early stage PCA has been increasing [3, 4]. Kikuchi et al reported that, in the United States after 1995, many smaller PCAs detected were located in the apex of the prostate: the frequency of apical cancer detection after 1995 had risen to 46% from 26%, a significant increase [5, 6]. Takashima et al in 2002 reported that in Japanese men, 82.3% of all T1c prostate tumors were located in the apex and were significantly denser compared to midprostate tumors [7].…”

Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla

“…• This may aid clinicians and patients in decision making for therapeutic modalities. Very distal apical prostate tumours: identifi cation on multiparametric MRI at 3 Tesla cancer increasing in frequency as well [ 2 ] . This is an area of the prostate that can be diffi cult to biopsy adequately in standard 10 -12-core transrectal ultrasound guided prostate schemes.…”

“…Prostate cancer is also the second leading cause of cancer‐related death in American men [1]. A significant percentage of men will have prostate cancer in the apex of the prostate, with some studies showing apical prostate cancer increasing in frequency as well [2]. This is an area of the prostate that can be difficult to biopsy adequately in standard 10–12‐core transrectal ultrasound guided prostate schemes.…”

Technical Advices for Prostate Needle Biopsy Under Transrectal Ultrasound Guidance

“…Also, several investigators suggested that early prostate cancers are often located in the anterior regions at the level of apex ( Figure 6). (Ishii J, et al 2007, Takashima R, et al 2002 Some physicians think that with using transperineal biopsy it is easy to get the appropriate samples from the TZ of the prostate. It may or may not be true.…”