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    Korean J Urol. 2006 Jun;47(6):578-585. Korean.
    Published online Jun 30, 2006.
    https://doi.org/10.4111/kju.2006.47.6.578
    Copyright © 2006 The Korean Urological Association
    Original Article

    The Anatomic Distribution and Pathological Characteristics of Prostate Cancer: A Mapping Analysis

    Taejin Kang, Cheryn Song, Gee Hyun Song, Gil Hyun Shin,1 Dong Ik Shin,1 Choung-Soo Kim and Hanjong Ahn
      • Department of Urology, University of Ulsan College of Medicine, Seoul, Korea.
      • 1Department of Biochemical Engineering, University of Ulsan College of Medicine, Seoul, Korea.
    • Corresponding author (Email: hjahn@amc.seoul.kr )
    Received January 04, 2006; Accepted January 28, 2006.

    Abstract

    Purpose

    We mapped the location of prostate cancer in Korean men, and investigated the volume and tumor distribution in relation to clinicopathological variables.

    Materials and Methods

    The volume of cancer and the anatomic location of each tumor foci were determined from 186 radical prostatectomy specimens, which were digitized to fit into a prototype prostate model. Using the computer-based digital images, the zonal cancer volume and distributional frequency were analyzed with respect to the clinical and pathological parameters, which were demonstrated in gray scales.

    Results

    The preoperative serum prostate-specific antigen (PSA) level ranged from 2.0 to 38.9ng/ml. The mean cancer volume of the 186 specimens was 4.5ml (median 1.9ml, range 0.01-37.7). The impalpable cancers were located more anteriorly and in the transition zone, and were also were smaller in volume (2.7ml vs. 5.5ml, p=0.004) than the palpable cancers. Cancers with seminal vesicle invasion were located more medially in the peripheral zone, and were larger in volume than organ-confined cancers or cancers with extracapsular extension (13.2ml vs. 3.0ml, p<0.001). For Gleason scores of 2-6, 7, and 8-10, the mean cancer volumes were 2.2, 3.7 and 8.2ml, respectively (p<0.001). High grade cancers were located more medially in the peripheral zone, especially when approaching the apex.

    Conclusions

    T1c cancers are located more anteriorly and in the transition zone; therefore, inclusion of these areas for targeted biopsy may help to improve the detection of cancer in patients with elevated PSA levels and impalpable prostate cancer. A medial location of seminal vesicle invasive cancers may imply an ejaculatory ducts route of invasion rather than a direct extracapsular extension.

    Keywords
    Prostate neoplasms; Maps; Tumor burden

    Figures

    Fig. 1
    Mapping method. Eight sequential prostate specimen slices are shown, with the red area indicating the focus of the cancer.

    Fig. 2
    Prostatic zonal anatomy and cancer foci. All cancer foci are plotted in each slice.

    Fig. 3
    Distribution of prostate cancer in all specimens. All cancer foci are stratified according to slices, and plotted using a gray-scale scheme. (A) Actual tumor distribution of all cancer foci. (B) Demonstration of frequent tumor location (upper 20% of frequency).

    Fig. 4
    Distribution of prostate cancer according to clinical stage. (A) Clinical stage T1c. (B) Clinical T2.

    Fig. 5
    Distribution of prostate cancer according to seminal vesicle invasion status. (A) Distribution of specimen without seminal vesicle invasion. (B) Distribution of specimen with seminal vesicle invasion.

    Fig. 6
    Distribution of prostate cancer according to the Gleason score. (A) Gleason score 2-6. (B) Gleason score 7. (C) Gleason score 8-10.

    Tables

    Table 1
    Patient characteristics and estimated tumor volume

    References

      1. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA cancer. J Clin 2000;50:7–33.
      1. 2001 Annual report of the Korea central cancer registry (based on registered data from 134 hospitals). Korea central cancer registry, ministry of health and welfare republic of Korea; 2003.
      1. Hodge KK, McNeal JE, Stamey TA. Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol 1989;142:66–70.
      1. 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;12:897–906.
      1. Chen ME, Johnston DA, Tang K, Babaian RJ, Troncoso P. Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 2000;89:1800–1809.
      1. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of non-palpable (stage T1c) prostate cancer. JAMA 1994;271:368–374.
      1. Igel TC, Knight MK, Young PR, Wehle MJ, Petrou SP, Broderick GA, et al. Systematic transperineal ultrasound guided template biopsy of the prostate in patients at high risk. J Urol 2001;165:1575–1579.
      1. Demura T, Hioka T, Furuno T, Kaneta T, Gotoda H, Muraoka S, et al. Differences in tumor core distribution between palpable and nonpalpable prostate tumors in patients diagnosed using extensive transperineal ultrasound-guided template prostate biopsy. Cancer 2005;103:1826–1832.
      1. Noguchi M, Stamey TA, McNeal JE, Yemoto CE. An analysis of 148 consecutive transition zone cancers: clinical and histological characteristics. J Urol 2000;163:1751–1755.
      1. McNeal JE, Bostwick DG. Anatomy of the prostate: implication for disease. In: Bostwick DG, editor. Pathology of the prostate. 1st ed. New York: Churchill-Livingstone; 1990. pp. 1-14.
      1. Stamey TA, Dietrick DD, Issa MM. Large, organ confined, impalpable transition zone prostate cancer: association with metastatic level of prostate specific antigen. J Urol 1993;149:510–515.
      1. Keetch DW, Catalona WJ. Prostatic transition zone biopsies in men with previous negative biopsies and persistently elevated serum prostate specific antigen values. J Urol 1995;154:1795–1797.
      1. McNeal J, Noldus J. Limitations of transition zone needle biopsy findings in the prediction of transition zone cancer and tissue composition of benign nodular hyperplasia. Urology 1996;48:751–756.
      1. Chen ME, Troncoso P, Tang K, Babaian RJ, Johnston D. Comparison of prostate biopsy schemes by computer simulation. Urology 1999;53:951–960.
      1. Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT. Cancer control with radical prostatectomy alone in 1000 consecutive patients. J Urol 2002;167:528–534.
      1. Villers AA, McNeal JE, Redwine EA, Freiha FS, Stamey TA. Pathogenesis and biological significance of seminal vesicle invasion in prostatic adenocarcinoma. J Urol 1990;143:1183–1187.
      1. Ohori M, Scardino PT, Lapin SL, Seale-Hawkins C, Link J, Wheeler TM. The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer. Am J Surg Pathol 1993;17:1252–1261.
      1. Lee F, Torp-Pedersen ST, Siders DB, Littrup PJ, McLeary RD. Transrectal ultrasound in the diagnosis and staging of prostatic carcinoma. Radiology 1989;170:609–615.
      1. Ayala AG, Ro JY, Babaian R, Troncoso P, Grignon DJ. The prostatic capsule: Does it exist? Its importance in the staging and treatment of prostatic carcinoma. Am J Surg Pathol 1989;13:21–27.
      1. Lee TK, Chung TG, Kim CS. Age-specific reference ranges for prostate specific antigen from a health center in Korea. Korean J Urol 1999;40:583–588.
      1. Lee SE, Kim DY, Kwak C. Interrelationship among age, prostate specific antigen and prostate volume in Korean men living at the Metropolitan area. Korean J Urol 1999;40:1311–1317.
      1. Cho HS, Kim CS, Ahn H. The pathological characteristics of localized prostate cancer, nanaged with radical prostatectomy. Korean J Urol 2002;43:938–943.
      1. Furuya Y, Ohta S, Sato N, Kotake T, Masai M. Comparison of T1c versus T2 prostate cancers in Japanese patients undergoing radical prostatectomy. Int Urol Nephrol 2002;33:73–76.
      1. Song CR, Kim JB, Chung H, Kim CS, Ro JY, Ahn HJ. Nomograms for the prediction of the pathological stage of the clinically localized prostate cancer in Korean men. Korean J Urol 2003;44:753–758.
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    MeSH Terms
    Biopsy
    Ejaculatory Ducts
    Fluconazole
    Humans
    Male
    Prostate*
    Prostate-Specific Antigen
    Prostatectomy
    Prostatic Neoplasms*
    Seminal Vesicles
    Tumor Burden
    Weights and Measures
    Metrics
    Share
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