The dedifferentiation of prostate carcinoma

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Prostate carcinoma histology is typically assessed using grading systems.
• The long-term stability of prostate cancer histological grade is not well understood.
• Transurethral resection of the prostate (TURP) is a common procedure for benign prostatic hyperplasia and can provide serial tissue samples.

Purpose of the Study:

• To investigate whether the histological grade of prostate carcinoma changes over time in the same patient.
• To determine the relationship between changes in prostate cancer grade and the development of metastases.

Main Methods:

• Retrospective analysis of 54 patients with prostate carcinoma who underwent two TURP procedures separated by 3 to 11 years.
• Histological grading of prostate carcinoma using the M. D. Anderson (MDAH) method for both TURP procedures.
• Assessment for evidence of metastases in relation to histological grade.

Main Results:

• A significant proportion of prostate carcinoma lesions dedifferentiated to a different grade between the first and second TURP: 73% of Grade 1, 75% of Grade 2, and 88% of Grade 3.
• Grade 4 lesions remained Grade 4 in all cases.
• Dedifferentiation correlated with an increased likelihood of metastases, with 0% for Grade 1, 19% for Grade 2, 55% for Grade 3, and 80% for Grade 4 lesions.

Conclusions:

• Prostate carcinoma commonly undergoes dedifferentiation over time.
• Dedifferentiation of prostate cancer is associated with a higher risk of developing metastases.
• Serial histological assessment may be valuable in monitoring prostate cancer progression.