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