The authors evaluated the pathological and oncological characteristics of anteriorly located prostate cancer (APC) in 728 RP specimens, and the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for APC evaluation. Patients were characterised as APC (70% or more of tumour anterior to urethra), PPC, or both involved (B-I). Of the 728 analysed, 226 (31%) were APC, 340 (46.7%) were PPC and 162 (22.3%) were B-I. Tumour volume was similar in the APC and PPC (14.9 vs. 16.9%). Preoperative prostate specific antigen (PSA) were also equivalent (9.2 vs. 8.6ng/mL). However, APC were less commonly palpable on digital rectal examination (DRE) (28.3% vs. 43.2%) and required more frequent repeat biopsies than PPC (10.2% vs. 4.7%). Biopsy Gleason grade (GG) was marginally lower in APC (6.8 vs. 7.0). GG was upgraded on final pathology more frequently in APCs than PPCs (34.5% vs. 23.2%), however it didn’t differ in terms of extracapsular extension, positive margins and lymph node involvement. Only the seminal vesicle involvement was lower in the APC group. Estimated five-year biochemical recurrence (BCR) free survival in the APC group was 87.5%, significantly higher than in the PPC plus B-I group (77.7%, P<0.001). The survival rate of APC group was higher than PPC for GG 7 but not for GG 6 or GG 8 and higher. However, the survival rate in patients with APC was better than PPC regardless of pathological stage. On multivariate analysis, anterior location was found to be an independent prognostic factor for BCR. Preoperative MRI findings were matched with postoperative pathological results. In anterior tumours, sensitivity and specificity was 78.1% and 58.2%, respectively, and was similar to the posterior tumours. APCs with suspicious lesions on MRI demonstrated poorer five-year BCR-free survival than APCs without lesions (85% vs. 100%), although this difference failed to reach statistical significance. The authors concluded that oncological outcomes of APC are better than those of PPC. MPM-MRI seems to be valuable to distinguish clinically significant APC.

Characteristics of anteriorly located prostate cancer (APC) and the usefulness of multiparametric magnetic resonance imaging (MP-MRI) for diagnosis.
Kim M, Choi S-K, Park M, et al.
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Zeeshan Aslam

Ninewells Hospital, Dundee, UK; Surgical Tutor, RCPS Glasgow.

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