PATTERN OF PROSTATIC DISEASE – A HISTOPATHOLOGICAL STUDY WITH CLINICAL CORRELATION”

Dr. Neena Kasliwal*, Dr. Monika Jain, Dr. Swarnlata Ajmera, Dr. Deepali Jain, Dr. Kalpana Sharma, Dr. Rohit Ajmera

ABSTRACT

BACKGROUND: Study of prostatic diseases pattern is of importance because incidence of prostatic disease, Nodular hyperplasia and carcinoma increases with age. Histopathologic analysis is an invaluable tool for exact diagnosis. OBJECTIVE: The present study has been planned with an aim to analyze the incidence of various morphologic types of Benign, Premalignant and Malignant Prostatic lesions and its correlation of the age distribution along with clinical manifestations. MATERIAL AND METHODS: This prospective present study deals with evaluation of various histological lesions in prostatic specimens in the department of pathology, JLN MEDICAL COLLEGE, AJMER from January 2012 to December 2013, period of 2 years .The study was approved by the institutional human research ethics committee. During the period of present study, 763 prostatic specimens were analyzed. Brief clinical data were noted from the case records, which included age, presenting symptoms, DRE (Digital Rectal Examination) findings, serum PSA(Prostate Specific Antigen) levels and clinical diagnosis. Statistical analysis was performed using descriptive statistics of the collected data. RESULTS: Majority of specimens were TURP (Transurethral Resection of Prostate) (91.74%) followed by prostatectomy 7.86% and needle biopsy 0.4%.Benign lesions were most common, which accounted for 70.77% followed by PIN in 19.13% and malignant lesions 10.09%. It was observed that Benign and PIN (Prostatic Intraepithelial Neoplasia) lesions were most common in seventh decade where as carcinoma was commonest in eight decade. This indicates that PIN possibly predates carcinoma by 10 years or more indicating PIN to be the precursor lesion for carcinoma. The cause of concern is that majority of carcinomas are of higher grade tumors. The positive predictive value for carcinoma was maximum in patients with serum PSA level >10 ng/ml i.e.59.42%.The positive predictive value was 27.2% for abnormal findings of DRE, 33.33% for PSA>4 ng/ml and 69.23% for the combination of both. Thus, the combination improves the detection rate of prostate cancer than serum PSA or DRE alone. CONCLUSION: Prostatic adenocarcinoma is a common disease that account for considerable morbidity and mortality in the ageing population. PIN has a high predictive value as a marker for adenocarcinoma, and its identification warrants repeat biopsy for concurrent or subsequent invasive carcinoma. Interpretation of prostatic biopsies has been, and continues to be a challenge to the pathologist. The cause of concern is that majority of carcinomas are of higher grade tumors. Combined staging, grading and follow- up study are required to obtain best predictive values.

Keywords: Prostatic adenocarcinoma, PIN, PSA.