CODE: 7.2 - Prostate cancer clinical stage at diagnosis
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Jakub Dobruch, Elza Modzelewska, Stanisław Szempliński, Przemysław Szostek, Artur A. Antoniewicz, Tomasz Dzik, Andrzej Borówka

Klinika Urologii CMKP, I Zespół Dydaktyki Urologicznej - Oddział Urologii Międzyleskiego Szpitala Specjalistycznego w Warszawie

summary

Introduction. Biopsy is used to diagnose prostate cancer (PCa). It is performed when increased PSA and/or abnormal results of digital rectal examination (DRE) and/or transrectal ultrasound (TRUS) are found. Prostate cancer stage is established when all above mentioned diagnostic tools results are known.

The aim of the study. The aim of the present study is to evaluate prostate cancer stage on the basis of the analysis of charts of men who underwent prostate biopsy in our department.

Material and methods. Data of men who were subjected to prostate biopsy (tru-cut core Bx) from 1st January 2000 to 15th March 2005 due to increased sPSA (. 0 ng/ml) and/or abnormal DRE and/or abnormal TRUS were analyzed. Formal biopsy (FLcoreBx) was performed in men who were not candidates for radical treatment and the biopsy was only done to confirm the existence of prostate cancer. The others underwent multiplace biopsy under TRUS guidance (TRUScoreBx).

Results. Prostate biopsy was performed in 854 men aged between 34 and 90 years (mean age - 69.15). The most prevalent group constitutes men aged from 70 to 79 years (44,8%). In 332 (38.9%) men the biopsy was carried out due to solely increased sPSA, whereas in 37 (4.3%) men due to solely abnormal DRE. Both of the diagnostic tools were the reasons to perform the biopsy in 370 (43.3%) men. Lesions found in TRUS were the only indication to do the biopsy in 6 (0.7%) men. In other 109 (12.8%) men beside increased sPSA or abnormal DRE prostate biopsy was carried out because of suggestive of PCa TRUS. PCa was found in 497 (58,2%) men. Clinically organ confined prostate cancer (cTŁ2) was diagnosed in 343 (69%) of them including 315 (74.8%) men who were subjected to TRUScoreBx and 28 (36,8%) men subjected to FLcoreBx. Extracapsular extension was shown in 154 (31%) patients. Among them, TRUScoreBx was done in 106 (25.2%) men. In men who underwent TRUScoreBx, T1c prostate cancer was most frequently diagnosed - 151 (35.9%) (table).

Table I. Clinical stage of prostate cancer in men who underwent the biopsy: multiplace (TRUScoreBx) or ,,formal" (FLcoreBx).

Among clinically organ confined prostate cancers, well differentiated (Gl.s.Ł6) tumors were most prevalent (82.8% of all organ confined tumors). The rate of low differentiated (Gl.s.ł7) cancers was the highest (36.4%) in men who were diagnosed with locally advanced PCa. The relation between the age of patients and prostate cancer stage was found: cancer was confined to the prostate in all men aged from 40 to 49 years and in 53.2% of men aged from 70 to 79 years. The relation between PSA and prostate cancer stage was also found: mean sPSA in men diagnosed with PCa staged T1c, cT2a, cT2b and cT3 was 22.3 ng/ml, 17.5 ng/ml, 30.1 ng/ml and 47 mg/ml respectively.

Conclusions. Clinically organ confined prostate cancer was diagnosed in more then 2/3 of patients with PCa. The risk of locally advanced prostate cancer increases with age and PSA of patients. In comparison to locally advanced PCa, differentiation of clinically organ confined prostate cancer on the whole is better. Basing on the current literature in countries with high prevalence of PSA local stage of newly diagnosed prostate cancer seems to be more favorable then in our material.