The Natural Course of Prostatic Carcinoma in Relation to Initial Cytological Grade

Abstract

We investigated retrospectively 91 patients with prostatic carcinoma diagnosed cytologically between 1978 and 1979. Of the patients 57 had no metastases (M0) at presentation. The majority of the patients without metastases had well or moderately well differentiated carcinoma. Of 18 patients with poorly differentiated carcinoma 17 had metastases at presentation. The patients without metastases were left untreated, while those with metastases received active antitumor treatment. Local progression and/or development of metastases during surveillance occurred in 24 patients (42 per cent) and antitumor treatment was initiated. Mean observation time in the group untreated throughout observation was 47 months. Mean interval to progression in the patients treated subsequently was 31 months. In the surveillance group no difference in mean interval to progression, frequency of local progression, development of metastases or death rate of prostatic carcinoma was found when the patients with initially well and moderately well differentiated carcinoma were compared. Therefore, in our study initial cytological grade failed to predict a difference in progression in patients with well and moderately well differentiated prostatic carcinoma. Since almost all patients with poorly differentiated carcinoma had metastases at presentation a poor differentiation seems to predict a worse prognosis compared to well and moderately well differentiated tumors.

Distribution of langerhans cells and HLA class II molecules in prostatic carcinomas of different histopathological grade

“…Carcinoma of the prostate has been until now the subject of extensive research with regard to factors influencing clinical behavior and ultimately the prognosis [22]; while it is well known that histopathological grading can offer important information at the two extremes of the grading system, as in the case of low-grade and high-grade adenocarcinomas, more uncertainty exists in the intermediate groups such as in grade 2-3 and 3-4 [4]. A recent study pointed out that the outcome is favorable in grade 1-2 adenocarcinomas and uniformly unfavorable in grade 4-5; the authors stated also that in the intermediate group some of the cases behaved aggressively while the others had a good prognosis but there were no morphological criteria to predict the clinical behavior Case 32.…”

“…Numerous studies have shown that histopathological grading is a good prognostic indicator, especially when dealing with the two opposite ends of the spectrum represented by well-differentiated (grades 1 and 2) and anaplastic carcinomas (grades 4 and 5 ) [3]; much uncertainty exists in the intermediate group, i.e., grades 2-3 and 3 carcinomas, in terms of biologic behavior since some of these neoplasms have an aggressive course and will kill patients, while others can be cured [4]. The histopathological grading seems also to be directly related to tumor mass, capsular and seminal vesicles invasion, and lymph node metastases [2].…”