Exploring Latent Prostate Cancer: A Forensic Autopsy Study in South India

Forensic autopsies offer a unique opportunity to study the natural history of prostate cancer (PCa), especially in individuals who had no prior diagnosis or long-term medical interventions. These examinations provide unbiased data on the true prevalence and progression of latent, asymptomatic prostate cancer. Unlike PSA screening-which often leads to overdiagnosis and unnecessary treatment-autopsy studies reveal clinically silent cases, particularly in older men. This prospective analysis was conducted to explore the prevalence and features of latent PCa in a South Indian population.

A study was conducted at a primary hospital in Vellore, Tamil Nadu, from August 2023 to April 2024. A total of 100 whole prostatectomy specimens were collected during forensic autopsies of male decedents aged 40-86 years, who had died under various medicolegal causes. Histopathological analysis was performed to identify the presence of latent prostate cancer. Data collected included basic history, cause of death, location of PCa, and Gleason scores.

Histopathological examination revealed that 9 out of 100 cases were diagnosed with invasive adenocarcinoma, with Gleason scores of 3 + 3 = 6 or 3 + 4 = 7, primarily in individuals aged over 60. The remaining 91 cases exhibited benign prostatic hyperplasia (BPH). These latent malignancies were more frequently found in individuals over the age of 60 years.

This study highlights the role of forensic autopsies in detecting latent prostate cancer that may have gone undiagnosed during life. By providing insight into the frequency and characteristics of prostate cancer in a defined geographic and demographic context, the findings contribute to the understanding of its natural history. The results emphasize the need for age-specific screening strategies and underscore the importance of comprehensive autopsy evaluations in uncovering hidden disease burdens in the population.