THE CLINICO-PATHOLOGIC PATTERNS OF PROSTATIC DISEASES AND PROSTATE CANCER IN SAUDI PATIENTS Hisham A. M. Mosli, FRCSC, FACS Taha A. Abdel-Meguid, MD Jaudah A. Al-Maghrabi, MD, FRCPC* Wisam K. Kamal, MBBS Hisham A. Saadah, MD* Hasan M. A. Farsi, FRCSC, FACS

Introduction: Little is known about the clinico- pathological nature of prostatic diseases in Saudi men For example: we still need to better define our local predisposition factors and the criteria for prognostic risk stratification Objective of study: to identify the features of prostatic diseases which is the initial step for adequate planning of health care

Material and methods: 2 major referral hospitals in Jeddah ◦KAUH: recently renamed KAUMC ◦KFSH & RC June 2003 – June patients Age range yrs., median 68 Medical records were reviewed for ◦Presentation ◦Results of DRE ◦PSA ◦Indications for biopsy or surgery ◦Histo-pathological diagnosis ◦Tumor grading, Gleason scoring

Material and methods: All pathological slides were reviewed by one pathologist (JAM) specializing in GU cancers Benign disease: ◦BPH ◦Inflammation:  degree ◦ Acute, chronic ◦ Focal, diffuse ◦ Peri-glandular, glandular & stromal Cancer:  Type: adenocarcinoma, others  Gleason grading & score

DiagnosisNo./Total(%) Adenocarcinoma94/330(28.5%) BPH143/330(43.3%) BPH with Inflammation67/330(20.3%) Inflammation14/330(4.2%) Others: TCC infiltration (8) SCC infiltration (1) Leiomyomatous nodules (1) Non Hodgkin’s lymphoma (1) Extension from colonic cancer (1) 12/330(3.6%) Overall Distribution Of Different Prostatic Disorders In 330 Prostatic Specimens Results:

Results: Indication No./Total (%) Elevated PSA46/54 (85%) Abnormal DRE 3/54 (5.5%) Elevated PSA +Abnormal DRE 5/54 (9.3%) Indications for prostatic TRUS biopsy in 54 patients with Prostate Cancer

PSA values at Diagnosis among 66 patients with Prostate Cancer PSA (ng/ml) Range: No./Total (%) 4>4> 9/66 (13.6%) /66 (13.6%) /66 (19.7%) >2035/66 (53.0%) Results:

Grade (Gleason Sum)No./Total (%) Well Differentiated (4/10) Total 3/83 (3.6%) Moderately Differentiated (5/10) (6/10) (7/10) Total 3/83 (3.6%) 25/83 (30%) 23/83 (27.7%) 51/83 (61.4%) Poorly Differentiated (8/10) (9/10) (10/10) Total 18/83 (21.7%) 9/83 (11.0%) 2/83 (02.4%) 29/83 (35.0%) Histological Grading And Gleason Score of 83 Patients With Prostate Cancer Results:

Results: There was an incidental finding of adenocarinoma in 14 out of 93 of Open & transurethral prostatectomy specimens i.e. Stages Ta & Tb =15% PSA less than 4ng/ml in 13.6% of cancer pateints Gleason score: out of the 83 prostate cancer specimens: ◦≥6 in 77 i.e. 92.8% and ◦≥7 in 52 i.e. 62.8%

Discussion More than a decade ago, our center (KAUH) reported a 7.2% rate of incidental prostate cancer detected in surgical specimens removed from clinically presumed benign disease (stages T1a and T1b), compared with international rates of 10-20% at that time Mosli HA. Incidental Adenocarcinoma of the Prostate: Frequency Rate at a Tertiary Care Hospital. Annals of Saudi Medicine 1997; 17:

A Study on 535 prostate specimens at KAUH, Jeddah : ◦54(10%) Prostate Cancer ◦481(90%) Benign lesions:  440(82.2%):BPH, 145(33%) were associated with inflammatory reaction: ◦ 133(24.9%): Chronic prostatitis ◦ 17(3.1): Acute prostatitis ◦ 5(0.9%): Chronic granulomatous prostatitis, 4 cases were T.B. Mansoor I: Pattern of Prostatic Diseases in Saudi Arabia, Internet Journal of Pathology, 2003, Vol.2 No.2 Previous Studies-Saudi Arabia

A study on 505 prostate specimens ◦75(15%) were prostate cancer ◦234(46%) were BPH with no other disorder ◦196(39%) were BPH associated with inflammatory reaction Zabar K, Jalal A, Ebrahim M: Retrospective Analysis of Patients with lower Urinary Tract Symptoms due Benign Prostatic Hyperplasia, Bahrain Med. Bull, 28(4), 2006 Previous Studies- Bahrain

Previous Studies -Oman A study on 1163 patients underwent TURP and prostate biopsies ◦10.9% were diagnosed as having prostate cancer ◦Unfortunately, Prostatitis was not looked at as it was considered a clinical diagnosis George E., Thomas S.: A histo-pathological Survey of Prostate Disease in The Sultanate of Oman. The Internet Journal of Pathology 2005, vol.2, no.2

Conclusions: Although the incidence of prostate cancer is low in Saudi Arabia, it usually takes place as high grade disease Incidental prostate cancer detected in surgical specimens removed from clinically presumed benign disease is rising Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5 rather than 4 ng/ml., otherwise we may miss a considerable number of our cancer patients

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