Stamatiou K

Frequency of impalpable prostate adenocarcinoma and precancerous conditions in Greek male population: an autopsy study

A series of 212 prostate specimens of men dead between August 2002–August 2004, have been sectioned in consecutive autopsies and subjected to whole mount analysis in purpose to determine the epidemiology of impalpable prostate cancer in Greece. Impalpable prostate carcinomas were found in 40 cases (18.8%) most in the peripheral region. In all, 29 of 40 impalpable cancers (70.7%) had volume less than 1 cm3. Most of impalpable carcinomas were of favorable (Gleason score 2–4) or intermediate (Gleason score 5 and 6) histological type (55 and 27.7%, respectively) while only five (12.5%) were undifferentiated (Gleason score 7 and 8). In all, 24 (60%) of the 40 impalpable carcinomas were multifocal and consisted of two or more foci, most of small size (<0.5 cm3). Most of the impalpable cancers found in this autopsy study were potentially insignificant tumors (relatively low volume, favorable or intermediate histological pattern and absence of invasiveness). Prostate intraepithelial neoplasia (PIN) coexisted with impalpable carcinomas, in almost half of the cancer-positive specimens. There was a positive correlation between PIN foci and coexistent cancer foci in most of the cases. Frequency rate and pathological features of both entities show significant variations in medical literature. Since the incidence of clinical prostate cancer in Greece is relatively low, and according to our autopsy findings, it is plausible that the frequency of clinical prostate cancer in a certain population could be related to the prevalent model of impalpable cancer as well as to the frequency and extend of the precancerous lesions.

Do clinically insignificant tumors of the prostate exist

Background: The discrepancy between minimal disease on biopsy and disease found in the subsequent prostatectomy specimen, in terms of the size and grade of tumor, extracapsular extension or positive margins, led several authors to dispute the existence of clinically insignificant impalpable tumors of the prostate. However, considering that prostate-specific antigen (PSA) is an indicator of prostate malignancy and since many impalpable prostatic carcinomas (PCs) are detected by a combination of PSA, transurethral ultrasound and needle biopsy (T1c), in the era of PSA screening, it is expected that most of the impalpable tumors found incidentally at transurethral resection of the prostate (stage T1a/b), could be clinically insignificant. Aim: The aim of this study was to identify the characteristics of latent, impalpable PCs and to analyze the incidence of clinically insignificant PCs among hypothetical stage T1 prostate cancers in tumors found incidentally at postmortem examination. Methods: We examined 40 cases of impalpable PCs found in 212 prostate autopsy specimens of men between 30 and 98 years of age who died of diseases other than carcinoma of the prostate and related conditions. Results: Most of T1 histological PCs (57.5%) had a Gleason score between 2 and 4, while 30% had Gleason score between 5 and 6. Only 5 (12.5%) had a Gleason score above 7. Twenty-nine of 40 stage T1 histological cancers (67.5%) had volume of <1 cm3. The highest volume tumors were those of intermediate and high grade (Gleason sums 5–8). Among tumors with volumes of <1 cm3, 96.55% were confined within the prostatic capsule. Conclusions: The majority of impalpable PCs were low-volume, well-differentiated tumors corresponding to clinically insignificant neoplasms. Similar characteristics could be attributed to most of the impalpable carcinomas detected after prostatectomy in clinical practice.

Dieta mediterránea y cáncer de próstata (Mediterranean diet and prostate cancer)

Un estudio necroscopico y epidemiologico llevado a cabo recientemente en la Universidad de Creta, sobre el cancer de prostata y los danos precancerigenos en la poblacion griega, revelo la aparicion, tanto en el cancer de prostata como en el de la PIN, con una frecuencia similar a la que se encontro en una muestra de la poblacion espanola (Sanchez Chapado M., et al. 2003), mas concretamente 18,88% a 19,26% y 27% a 31,7%. La prevalencia de ambos, tanto de los danos del tejido como del cancer de prostata, parece ser considerablemente mas baja en las poblaciones mediterraneas que en el resto de las caucasicas. Basandose en los conceptos subordinados de la dieta en la epidemiologia del cancer de prostata y, en el supuesto de que los estudios recientes de epidemiologia tanto en Espana como en Grecia, registran una preferencia por la dieta mediterranea en ambos pueblos (Tichopoulou et al., 2003 Lasheras C., et al, 2000), consideramos que es posible que la dieta mediterranea cohiba notablemente, ya en una fase previa, la creacion del cancer de prostata. Se requieren mas estudios paralelos de la epidemiologia y de la genetica en las poblaciones mediterraneas para corroborar esta hipotesis.