Prostate inflammation. Association with benign prostatic hyperplasia and prostate cancer

To study the association and possible relationship of prostate inflammation with benign prostatic hyperplasia [BPH], and prostate cancer. The medical records and pathological findings of all Saudi patients who underwent transrectal ultrasound guided prostatic needle biopsies in King Abdulaziz University Medical City, Jeddah,Kingdom of Saudi Arabia from June 2003 to June 2008 were reviewed retrospectively. The indications for biopsy were elevated levels of serum prostate specific antigen, abnormal findings on digital rectal examination, or both. The specimens harboring inflammation, adenocarcinoma, BPH, or their combinations, were selected and included in the study. A total of 214 patients were selected with an age ranging from 37-100 years [median=68]. Inflammation was histologically evident in 88 patients. Of them, only one demonstrated acute inflammation, while 87/88 demonstrated chronic inflammation with, or without acute inflammation. Histopathologic features were categorized into 3 main categories: inflammation alone [12/214, 5.6%], BPH category [126/214, 58.9%], and cancer category [76/214, 35.5%] patients. The last 2 categories also included cases associated with inflammation. In the overall analysis of 214 specimens, BPH with inflammation was more prevalent than cancer with inflammation [43/214 [20.1%] versus 33/214 [15.4%]]. In a subgroup analysis within each category, inflammation was less prevalent in the BPH category compared to the cancer category [43/126 [34.1%] versus 33/76 [43.4%]]. The association between chronic inflammation and both BPH and cancer is obvious in our study. Further studies are needed to substantiate this observation, and to clarify the magnitude of association of inflammation with BPH compared to cancer

clinicopathologic patterns of prostatic diseases and prostate cancer in Saudi patients

To determine the clinicopathologic patterns of prostatic diseases in Saudi patients, with special emphasis on prostate cancer [PCa]. The records of patients who underwent histopathological examinations of their prostatic specimens in King Abdulaziz University Medical City and King Faisal Specialist Hospital, Jeddah, Kingdom of Saudi Arabia, between June 2003 and June 2008 were reviewed retrospectively. The age, indications for biopsy, histological diagnosis, and Gleason grading of cancer patients, were studied. The study included 330 patients aged 37-100 years [median=68]. Specimens included 233 transrectal ultrasound [TRUS] biopsies, 85 transurethral resection of the prostate [TURP], 8 simple prostatectomies, 3 radical prostatectomies, and one radical cystoprostatectomy. Indications for TRUS guided biopsy in PCa patients were elevated prostate specific antigen [PSA] [85.2%], abnormal digital rectal examination [5.5%] or both [9.3%]. Prostate specific antigen values <4 ng/ml were found in 13.6% of PCa patients. Among others, adenocarcinoma was found in 28.5%, benign prostatic hyperplasia [BPH] alone in 43.3%, BPH with inflammation in 20.3% and inflammation alone in 4.2%. In specimens of TURP or simple prostatectomy for apparently benign disease, incidental PCa was detected in 14/93 [15%]. The Gleason sum of >/= 6 was found in 92.8% of patients. The incidence of prostate cancer in Saudi Arabia is low compared to the western countries. However, incidental PCa detected in presumed benign disease appears to be rising. Further future studies addressing this issue are needed to confirm the potential rising trend, and its possible etiology. Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5 rather than 4ng/ml