Prostatic diseases under focus in a university hospital in Eastern Saudi Arabia A 15-year experience Areej M. Al Nemer, MD, Reem B. Aldamanhori, MD.

ABSTRACT

‫ معرفة مختلف أمراض البروستاتا التي تشخص في‬:‫األهداف‬ ‫اخلزعات اجلراحية للبروستاتا من الرجال السعوديني في مختلف‬ ‫ واختبار ما إذا كان معدل السرطانات قد تغير‬،‫الفئات العمرية‬ ‫ وتقييم العالقة بني االلتهاب‬،‫ املاضية‬15 ‫على مدى السنوات ال‬ )BPH( ‫) مع كل من تضخم البروستاتا احلميد‬CI( ‫املزمن‬ ‫ والتحقق من النتائج النسيجية للحاالت التي‬،)PCa( ‫والسرطان‬ .)AUR( ‫عرضت مع احتباس البول احلاد‬ ‫ هذه دراسة استعادية تشمل جميع خزعات البروستاتا‬:‫الطريقة‬ ‫املتوفرة في ملفات مختبر علم األمراض اجلراحي في مستشفى‬ 15 ‫ اململكة العربية السعودية خالل‬،‫امللك فهد اجلامعي باخلبر‬ ،‫ متت مراجعة العمر‬.‫) للرجال السعوديني‬1999-2013( ‫عام ًا‬ .‫ وجرى استعراض الشرائح‬،‫سبب اخلزغة والتشخيص النهائي‬ 65 ‫ متوسط عمر املرضى بلغ‬،‫ حالة‬360 ‫ شملت الدراسة‬:‫النتائج‬ ‫ في حني شكلت‬،)64.7%( ‫ الغالبية العظمى‬BPH ‫ ألف‬.ً‫عاما‬ ‫ مت تشخيص‬.‫ منها كانت عرضية‬13.5% ،‫ حالة‬89 ‫السرطانات‬ .‫ أو خبيثة في العقد السابع‬BPH ‫معظم احلاالت سواءاً حميدة‬

‫لم يظهر سرطان البروستاتا تغيراً متواتراً من ارتفاع أو سقوط في‬ ‫ االلتهاب املزمن يتعلق بالتضخم‬.‫معدل التشخيص على مر الزمن‬ ‫ عالقة ذات داللة‬CI ‫ أظهر فقط‬.‫ أكثر من اخلبيث‬BPH ‫احلميد‬ .AUR ‫إحصائية مع‬ .‫ يظهر سرطان البروستاتا معدل مستقر مع مرور الوقت‬:‫اخلامتة‬ ‫ اال انه يرتبط‬،PCa‫ و‬BPH ‫ هو قاسم مشترك لكال‬CI ‫في حني‬ ‫ له عالقة‬CI ‫ فقط‬،‫ بني جميع النتائج النسيجية‬.BPH ‫أكثر مع‬ .AUR ‫احصائية وثيقة مع‬

Objectives: To explore the spectrum of pathologies diagnosed in prostatic biopsies of Saudi men, and test whether the frequency of diagnosing the malignant fraction has been changed over the last 15 years, and assess the association between chronic inflammation

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(CI) with both benign prostatic hyperplasia (BPH) and cancer (PCa), and investigate the histological findings of cases presented with acute urinary retention (AUR) clinically. Methods: This is a retrospective cohort study including all prostatic biopsies accessed in the files in the Surgical Pathology Laboratory of King Fahd University Hospital, Alkhobar, Kingdom of Saudi Arabia over 15 years (1999-2013) for Saudi men. Age, procedure indication, and final diagnoses were retrieved and slides were reviewed. Results: There were 360 cases included in this study with a median age of 65 year-old. The BPH comprised the most (64.7%), while PCa accounted for 89 cases, 13.5% of which were incidental. Most cases of both BPH and PCa were diagnosed in the seventh decade. The frequency of diagnosing PCa did not show a solid rise or fall over time. Chronic inflammation is more related to BPH than to PCa. Only CI showed a significant statistical association with AUR. Conclusion: Prostatic diseases show a stable trend over time. While CI is a common dominator for both BPH and PCa, it is associated more with BPH. Among all histological findings, only CI is related to the clinical presentation of AUR. Saudi Med J 2015; Vol. 36 (11): 1319-1323 doi: 10.15537/smj.2015.11.12654 From the Departments of Surgical Pathology (Al Nemer), Urology (Aldamanhori), University of Dammam, King Fahd Hospital of the University, Alkhobar, Kingdom of Saudi Arabia. Received 1st July 2015. Accepted 30th September 2015. Address correspondence and reprint request to: Dr. Areej M. Al Nemer, Department of Surgical Pathology, University of Dammam, King Fahd Hospital of the University, Alkhobar, Kingdom of Saudi Arabia. E-mail: [email protected]

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Saudi Med J 2015; Vol. 36 (11)

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Prostatic diseases in Saudis ... Al Nemer & Aldamanhori

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he spectrum of prostatic diseases is a common health concern all over the world. While benign prostatic hyperplasia (BPH) is the most frequent urologic diagnosis in elderly males worldwide, affecting approximately one third of males in their 60’s,1,2 prostatic carcinoma (PCa) is the second most common cause of cancer-related death in males after lung cancer.3 The disease represents clear racial and national differences, with its highest incidence in blacks in the West, and lowest in Asian males.4 Recently, there has been a rising trend for PCa in populations that are thought to be of low risk.5 Furthermore, the relationship between chronic inflammation (CI) and presence and progression of both BPH and PCa is controversial.6-9 On the other hand, acute urinary retention (AUR), which is the most frequent emergency in urology, is mostly developed in a background of BPH.10 Whether other pathologies, such as CI and infarction increase the risk of this complication is debated.11-13 In this work, we retrospectively reviewed the whole spectrum of prostatic pathologies diagnosed in our center during the last 15 years, including prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP), and study various diseases in relation to age of diagnosis, explore the change in trend of diagnosing PCa over a period witness an increase in screening and gradual westernization of lifestyle, test the relationship between CI and both BPH and PCa, and also, we investigate the role of different biopsy findings in relation to the clinical presentation with AUR. Methods. This is a retrospective laboratory based study. After institutional review board approval, all prostatic biopsies routinely submitted and archived as a part of diagnostic histopathology service for Saudi citizens in the Surgical Pathology Laboratory of King Fahd Hospital of the University, Alkhobar, Kingdom of Saudi Arabia from January 1999 to December 2013 were included. The types of biopsies were trans-rectal ultrasound guided (TRUS), trans-urethral resection of the prostate (TURP), and resection. Patient’s age, indications for the procedure, and final diagnoses were retrieved from pathology reports. Patients with more than one specimen were counted only once, even if not excised at the same time to avoid duplication. If different procedures were carried out, TRUS were the one counted due to the higher expected yield. Slides Disclosure. Authors have no conflict of interest, and the work was not supported or funded by any drug company.

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for selected cases were reviewed. Different pathological diagnoses were stratified according to the year of procedure, as well as age clustered in 8 groups starting at age of 30 years, each is 10-year interval. Chronic inflammation (defined by the presence of localized aggregates of mononuclear inflammatory cells including lymphocytes, plasma cells and histiocytes) was tested for possible association with both benign hyperplasia and cancer categories. Also, histological findings were evaluated for correlation with the clinical presentation with AUR.11-13 All data were tabulated and analyzed using Microsoft Excel 2010 and GraphPad Prism 6 software 2014. Results were considered to be significant if p

Prostatic diseases under focus in a university hospital in Eastern Saudi Arabia. A 15-year experience.

To explore the spectrum of pathologies diagnosed in prostatic biopsies of Saudi men, and test whether the frequency of diagnosing the malignant fracti...
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