Transition zone and anterior stromal prostate cancers: Zone of origin and intraprostatic patterns of spread at histopathology

Bouyé, S.; Potiron, E.; Puech, Philippe; Leroy, Xavier; Lemaître, L.; Villers, Arnauld

doi:10.1002/pros.20859

Cited by 95 publications

(61 citation statements)

References 18 publications

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“…In this study, an additional 123 patients, corresponding to 12% of the initial cohort, were diagnosed with prostate cancer after undergoing a second, third, or fourth repeat biopsy (4). The TRUS-guided biopsy technique is known to frequently overlook cancers in the anterior region of the prostate, where approximately 30% of cancers reside (5). Therefore, the false negative rate of TRUS-guided biopsies is a major concern.…”

Section: Discussionmentioning

confidence: 99%

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Durmus¹,

Reichelt²,

Huppertz³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate prostate cancer detection rate of magnetic resonance imaging (MRI)-guided biopsy and to elucidate possible relations to the number of prior negative transrectal ultrasonography (TRUS)-guided biopsies. MATERIALS AND METHODSEighty-seven consecutive patients (mean age, 65.0 years; mean prostate-specific antigen, 13.3 ng/mL) with at least one prior negative TRUS-guided biopsy and persistent suspicion of prostate cancer were included in this study. All patients underwent MRI-guided biopsy after a diagnostic multiparametric MRI examination at 1.5 Tesla. Specimens were immediately fixated and subsequently evaluated by an experienced uropathologist. Prostate cancer detection rates were calculated. Prostate cancer-positive and -negative cores were compared. Correlation between number of prior biopsies and presence of prostate cancer was evaluated. RESULTSCancer detection rates for patients with one (n=24), two (n=25), three (n=18), and four or more (n=20) negative TRUS-guided biopsies were 29.2%, 40.0%, 66.7%, and 35.0%, respectively (P = 0.087). The median number of removed cores per patient was 3 (range, 1-8) without a significant difference between patients with and without cancer (P = 0.48). Thirty of 36 cancer patients were at intermediate or high risk according to the D´Amico clinical risk score. Eleven of 15 high risk cancers were localized in the transition zone (P = 0.002). CONCLUSIONSThis study demonstrates high cancer detection rates of MRI-guided biopsy independent of the number of previous TRUS-guided biopsies and the number of taken prostate cores. MRI-guided biopsy therefore represents a less invasive and effective diagnostic tool for patients with prostate cancer suspicion and previous negative TRUS-guided biopsies.

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Section: Discussionmentioning

confidence: 99%

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

Durmus¹,

Reichelt²,

Huppertz³

et al. 2013

Diagn Interv Radiol

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“…A cancer was considered as originated from transition zone if 470% of its surface was located in this zone, as previously described. 15,22 A transition zone prostate cancer was identified in 62/397 (16%) patients who constituted our study population. Patients were diagnosed through PSA screening and/or digital rectal examination.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, transition zone tumors and cancers arising in the most anterior horns of the peripheral zone have been further characterized and grouped together under the designation of 'anterior-predominant prostatic tumors,' to be distinguished from those arising in the posterior peripheral zone. 21 Lately, Bouye et al 22 have studied the zone of origin and patterns of spread of anterior prostate cancers, comprising tumors of transition zone and anterior fibromuscular stroma, and concluded that the contours and location of these cancers are predictable and conform to histological zones boundaries. Transition zone tumors are rarely unifocal and are often associated with peripheral zone cancer foci.…”

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confidence: 99%

ERG rearrangement is present in a subset of transition zone prostatic tumors

et al. 2010

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A majority of prostate cancers exhibit a recurrent gene rearrangement involving chromosome 21. In approximately 90% of cases, the rearrangement is characterized by fusion of the androgen-regulated gene TMPRSS2 with the oncogene ERG. A recent study suggested that TMPRSS2-ERG gene fusion is lacking in cancers arising from the transition zone of the prostate. A dominant transition zone cancer was detected in 62/397 (16%) patients who underwent radical prostatectomy at our institution and were reviewed and mapped by a single pathologist. In 46/62 specimens, a secondary tumor was identified in the peripheral zone of the prostate. A tissue microarray containing both transition and peripheral zone tumors was constructed and evaluated for gene fusion analysis. TMPRSS2-ERG fusion status was determined using a multicolor interphase fluorescence in situ hybridization assay for ERG break-apart. The median age of the patients was 59 years. Prostatectomy Gleason score was 6 in 21, 7 in 34, and Z8 in 7 cases. Median tumor volume was 200 mm 2 . TMPRSS2-ERG gene fusion was present in 7/59 (12%) transition zone, and in 12/35 (34%) peripheral zone tumors. Transition zone fusion-positive cases were larger than their negative counterparts. No significant correlation was found between fusion status and Gleason score or pathologic stage. Gene fusion through deletion occurred in 4/7 transition zone and 7/12 peripheral zone tumors. Transition zone prostate cancers are considered biologically and genetically different from peripheral zone tumors. Although ERG rearrangement is more common in peripheral zone tumors, we have detected TMPRSS2-ERG fusion in a subset of transition zone cancers (12%). The lower frequency of gene fusion in transition zone prostate cancer may suggest distinct molecular alterations from peripheral zone tumors and the association with a high tumor volume may indicate a growth advantage for transition zone tumors harboring the gene fusion. Further studies are necessary to confirm this hypothesis.

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“…2 The negative predictive value was 95 %. Mean cancer volume detected at MRI was 2.44 ml (range 0.02-14.5) and mean cancer volume not detected at MRI was 0.16 ml (range 0.01-2.4).…”

Section: Multiparametric Magnetic Resonance Imagingmentioning

confidence: 96%

The Role of Imaging in Suspected Prostate Cancer

Ouzzane¹,

Villers²

2011

European Oncology &Amp; Haematology

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Among a multitude of tests available to evaluate patients with suspected prostate cancer, modern imaging techniques seem to be the most relevant and their use is growing fast. Magnetic resonance imaging (MRI) technology is the most important imaging tool for identifying early prostate cancers, characterising tumours, helping in patient risk stratification and enabling focused use of biopsy. In addition, recent advances in transrectal ultrasonography of the prostate, such as realtime tissue elastography and contrast-enhanced ultrasonography, allow better identification of cancer. The optimal prostate cancer diagnostic strategy has to be validated. However, one way of improving identification in patients referred for screening might be pre-biopsy MRI, which would provide guidance for targeting biopsies. A 'targeted biopsies only' strategy (that is, without systematic biopsies) may reduce the number of biopsies (indicated only in patients with positive imaging), therefore avoiding the potentially unnecessary diagnosis of insignificant cancer. Any prospective, randomised trial testing MRI as an adjunct or replacement for biopsies will need to be carefully designed to include cost-utility and cost-effectiveness analysis of imaging. KeywordsProstatic neoplasm, cancer diagnosis, imaging techniques, magnetic resonance imaging, ultrasound, biopsy, observation, focal therapy Ultrasound TechniquesTransrectal Ultrasonography

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Transition zone and anterior stromal prostate cancers: Zone of origin and intraprostatic patterns of spread at histopathology

Cited by 95 publications

References 18 publications

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

MR-guided biopsy of the prostate: correlation of cancer detection rate with number of previous negative TRUS biopsies

ERG rearrangement is present in a subset of transition zone prostatic tumors

The Role of Imaging in Suspected Prostate Cancer

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