Prostate-specific antigen-detected prostate cancer (Stage T1c): An analysis of whole-mount prostatectomy specimens

Abstract Background Late diagnosis of prostate cancer is common in Uganda and elsewhere. Diagnosis in advanced stages is associated with high mortality, morbidity and low quality of life. We estimated time taken from perception of symptoms attributable to prostate cancer to biopsy among patients with prostate cancer at the Uganda Cancer Institute (UCI) and the associated factors. Methods We conducted a retrospective cohort analysis of records of 280 patients with histologically confirmed diagnosis of prostate cancer at UCI from January 2016 to December 2017. Time to diagnosis was obtained from the difference between the approximate date of onset of initial symptoms and date when a biopsy was taken. Late diagnosis was that when an individual was diagnosed with prostate cancer stage III or IV whereas stages I and II were classified as early. We used modified poisson regression to assess factors associated with timing of diagnosis among patients. Results The median time from first perceived symptoms to biopsy for prostate cancer patients was 12 (IQR5-24) months and 76% were diagnosed after 4 months of symptoms. Median age at time of diagnosis of patients was 70 (IQR66-74.5) years and at least 50% were aged between 65-74 years. About 81.8% of the patients were diagnosed late; of which 35.7% were in stage III and 46.1% were in stage IV. Nearly all patients presented with raised prostate specific antigen with median prostate specific antigen of 100.2 (IQR36.02-350) ng/ml of blood at the time of admission. In adjusted analysis, a patients whose biopsies were taken before 5 months of recognising symptoms were two times as likely to have cancer stage I and II compared to those patients in whom the biopsies were taken after 4 months. Conclusion More than three in four patients were diagnosed late. Taking a biopsy after 4 months of initiation of symptoms was partially responsible for the delay. To improve time to diagnosis, communities should be educated about symptoms of prostate cancer and advised to seek health care early. Health care workers should be sensitised to suspect prostate cancer among patients to allow timely referral for appropriate specialised assessment and management.

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Late Diagnosis among patients with Prostate Cancer at the Uganda Cancer Institute: A retrospective cohort study

10.21203/rs.2.11766/v1 ◽

2019 ◽

Author(s):

Nelson Bunani ◽

Angela Nakanwagi Kisakye ◽

Aloysius Ssennyonjo ◽

Fred Nuwaha

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Prostate Specific Antigen ◽

Retrospective Cohort ◽

Specific Antigen ◽

Late Diagnosis ◽

Stage Iii ◽

Cancer Stage ◽

Initial Symptoms ◽

Time To Diagnosis

Abstract Background Late diagnosis of prostate cancer is common in Uganda and elsewhere. Diagnosis in advanced stages is associated with high mortality, morbidity and low quality of life. We estimated time taken from perception of symptoms attributable to prostate cancer to biopsy among patients with prostate cancer at the Uganda Cancer Institute (UCI) and the associated factors. Methods We conducted a retrospective cohort analysis of records of 280 patients with histologically confirmed diagnosis of prostate cancer at UCI from January 2016 to December 2017. Time to diagnosis was obtained from the difference between the approximate date of onset of initial symptoms and date when a biopsy was taken. Late diagnosis was that when an individual was diagnosed with prostate cancer stage III or IV whereas stages I and II were classified as early. We used modified poisson regression to assess factors associated with timing of diagnosis among patients. Results The median time from first perceived symptoms to biopsy for prostate cancer patients was 12 (IQR5-24) months and 76% were diagnosed after 4 months of symptoms. Median age at time of diagnosis of patients was 70 (IQR66-74.5) years and at least 50% were aged between 65-74 years. About 81.8% of the patients were diagnosed late; of which 35.7% were in stage III and 46.1% were in stage IV. Nearly all patients presented with raised prostate specific antigen with median prostate specific antigen of 100.2 (IQR36.02-350) ng/ml of blood at the time of admission. In adjusted analysis, a patients whose biopsies were taken before 5 months of recognising symptoms were two times as likely to have cancer stage I and II compared to those patients in whom the biopsies were taken after 4 months. Conclusion More than three in four patients were diagnosed late. Taking a biopsy after 4 months of initiation of symptoms was partially responsible for the delay. To improve time to diagnosis, communities should be educated about symptoms of prostate cancer and advised to seek health care early. Health care workers should be sensitised to suspect prostate cancer among patients to allow timely referral for appropriate specialised assessment and management.

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Late Diagnosis among patients with Prostate Cancer at the Uganda Cancer Institute: A retrospective cohort study.

10.21203/rs.2.11766/v3 ◽

2020 ◽

Author(s):

Nelson Bunani ◽

Angela Nakanwagi Kisakye ◽

Aloysius Ssennyonjo ◽

Fred Nuwaha

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Prostate Specific Antigen ◽

Retrospective Cohort ◽

Specific Antigen ◽

Late Diagnosis ◽

Stage Iii ◽

Cancer Stage ◽

Initial Symptoms ◽

Time To Diagnosis

Abstract Background Late diagnosis of prostate cancer is common in Uganda and elsewhere. Diagnosis in advanced stages is associated with high mortality, morbidity and low quality of life. We estimated time taken from perception of symptoms attributable to prostate cancer to biopsy among patients with prostate cancer at the Uganda Cancer Institute (UCI) and the associated factors. Methods We conducted a retrospective cohort analysis of records of 280 patients with histologically confirmed diagnosis of prostate cancer at UCI from January 2016 to December 2017. Time to diagnosis was obtained from the difference between approximate date of onset of initial symptoms and date when a biopsy was taken. Late diagnosis was that when an individual was diagnosed with prostate cancer stage III or IV whereas stages I and II were classified as early. We used modified Poisson regression to assess factors associated with timing of diagnosis among the patients. Results The median time from first perceived symptoms to biopsy for prostate cancer patients was 12 (IQR 5-24) months and 76% were diagnosed after 4 months of symptoms. Median age at time of diagnosis of patients was 70 (IQR66-74.5) years and at least 50% were aged between 65-74 years. About 81.8% of patients were diagnosed late; of which 35.7% were in stage III and 46.1% were in stage IV. Nearly all patients presented with raised prostate specific antigen with a median prostate specific antigen of 100.2 (IQR 36.02-350) ng/ml of blood at the time of admission. In adjusted analysis, patients whose biopsies were taken before 5 months of recognising symptoms were two times as likely to have cancer stage I and II compared to those patients in whom the biopsies were taken after 4 months. Conclusion More than three in four patients were diagnosed late. Taking a biopsy after 4 months of initiation of symptoms was partially responsible for the delay. To improve time to diagnosis, communities should be educated about symptoms of prostate cancer and advised to seek health care early. Health care workers should be sensitised to suspect prostate cancer among patients to allow timely referral for specialised assessment and management.

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Clonal evaluation of early onset prostate cancer by expression profiling of ERG, SPINK1, ETV1, and ETV4 on whole mount radical prostatectomy tissue

10.1101/667832 ◽

2019 ◽

Cited By ~ 1

Author(s):

Zhichun Lu ◽

Sean R. Williamson ◽

Shannon Carskadon ◽

Pavithra D. Arachchige ◽

Gaury Dhamdhere ◽

...

Keyword(s):

Prostate Cancer ◽

Family History ◽

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Early Onset ◽

Biochemical Recurrence ◽

African American Men ◽

Expression Profiles ◽

Specific Antigen ◽

Whole Mount

ABSTRACTExpression profiles of ETS related genes and SPINK1 in early onset prostate cancer have not been thoroughly explored. We retrieved 151 radical prostatectomy specimens from young men with prostate cancer (<55yrs) and characterized the expression of ERG, SPINK1, ETV1 and ETV4 by dual immunohistochemistry and dual RNA in-situ hybridization. Age, race, family history, preoperative prostate-specific antigen, biochemical recurrence and pathological variables using whole mount radical prostatectomy tissue were collected. 313 tumor nodules from 151 men including 68 (45%) Caucasians and 61 (40%) African Americans. Positive family history of prostate cancer was observed in 65 (43%) patients. Preoperative prostate-specific antigen ranged from 0.3 to 52.7 ng/ml (mean 7.04). Follow-up period ranged from 1 to 123.7 months (Mean 30.3). Biochemical recurrence was encountered in 8/151 (5%). ERG overexpression was observed in 85/151 (56%) cases, followed by SPINK1 in 61/151 (40%), ETV1 in 9/149 (6%), and ETV4 in 4/141 (3%). There were 25/151 (17%) cases showing both ERG and SPINK1 overexpression within different regions of either the same tumor focus or different foci. Higher frequency of ERG overexpression was seen in younger patients (≤ 45 years old) (76% vs. 49%, p = 0.002213), Caucasian men (71% vs. 41% p = 0.000707), organ-confined tumors (64% vs. 33%, p = 0.00079), and tumors of Grade Groups 1 and 2 (62% vs. 26%, p = 0.008794). SPINK1 overexpression was more in African American men (68% vs. 26%, p = 0.00008), in tumors with high tumor volume (> 20%) and with anterior located tumors. ETV1 and ETV4 demonstrated rare overexpression in these tumors, particularly in the higher-grade tumors. This study expands the knowledge of the clonal evolution of multifocal cancer in young patients and support differences in relation to racial background and genetics of prostate cancer.

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