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THE CLINICO-PATHOLOGIC PATTERNS OF PROSTATIC DISEASES AND PROSTATE CANCER IN SAUDI PATIENTS

THE CLINICO-PATHOLOGIC PATTERNS OF PROSTATIC DISEASES AND PROSTATE CANCER IN SAUDI PATIENTS. Hisham A . M. Mosli , FRCSC, FACS Taha A. Abdel- Meguid , MD Jaudah A. Al- Maghrabi , MD, FRCPC* Wisam K. Kamal , MBBS Hisham A. Saadah , MD* Hasan M. A. Farsi, FRCSC, FACS.

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THE CLINICO-PATHOLOGIC PATTERNS OF PROSTATIC DISEASES AND PROSTATE CANCER IN SAUDI PATIENTS

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  1. THE CLINICO-PATHOLOGIC PATTERNS OF PROSTATIC DISEASES AND PROSTATE CANCER IN SAUDI PATIENTS Hisham A. M. Mosli, FRCSC, FACS Taha A. Abdel-Meguid, MD Jaudah A. Al-Maghrabi, MD, FRCPC* Wisam K. Kamal, MBBS Hisham A. Saadah, MD* Hasan M. A. Farsi, FRCSC,FACS

  2. Little is known about the clinico-pathological nature of prostatic diseases in Saudi men • For example: we still need to better define our local predisposition factors and the criteria for prognostic risk stratification • Objective of study: to identify the features of prostatic diseases which is the initial step for adequate planning of health care Introduction:

  3. 2 major referral hospitals in Jeddah • KAUH: recently renamed KAUMC • KFSH & RC • June 2003 – June 2008 • 330 patients • Age range 37-100 yrs., median 68 • Medical records were reviewed for • Presentation • Results of DRE • PSA • Indications for biopsy or surgery • Histo-pathological diagnosis • Tumor grading, Gleason scoring Material and methods:

  4. All pathological slides were reviewed by one pathologist (JAM) specializing in GU cancers • Benign disease: • BPH • Inflammation: • degree • Acute, chronic • Focal, diffuse • Peri-glandular, glandular & stromal • Cancer: • Type: adenocarcinoma, others • Gleason grading & score Material and methods:

  5. Overall Distribution Of Different Prostatic Disorders In 330 Prostatic Specimens Results:

  6. Indications for prostatic TRUS biopsy in 54 patients with Prostate Cancer Results:

  7. Results: PSA values at Diagnosis among 66 patients with Prostate Cancer

  8. Results: Histological Grading And Gleason Score of 83 Patients With Prostate Cancer

  9. There was an incidental finding of adenocarinoma in 14 out of 93 of Open & transurethral prostatectomy specimens i.e. Stages Ta & Tb =15% • PSA less than 4ng/ml in 13.6% of cancer pateints • Gleason score: out of the 83 prostate cancer specimens: • ≥6 in 77 i.e. 92.8% and • ≥7 in 52 i.e. 62.8% Results:

  10. More than a decade ago, our center (KAUH) reported a 7.2% rate of incidental prostate cancer detected in surgical specimens removed from clinically presumed benign disease (stages T1a and T1b), compared with international rates of 10-20% at that time Discussion • Mosli HA. Incidental Adenocarcinoma of the Prostate: Frequency Rate at a Tertiary Care Hospital. Annals of Saudi Medicine 1997; 17: 662-664.

  11. A Study on 535 prostate specimens at KAUH, Jeddah : • 54(10%) Prostate Cancer • 481(90%) Benign lesions: • 440(82.2%):BPH, 145(33%) were associated with inflammatory reaction: • 133(24.9%): Chronic prostatitis • 17(3.1): Acute prostatitis • 5(0.9%): Chronic granulomatousprostatitis, 4 cases were T.B. Previous Studies-Saudi Arabia Mansoor I: Pattern of Prostatic Diseases in Saudi Arabia, Internet Journal of Pathology, 2003, Vol.2 No.2

  12. A study on 505 prostate specimens • 75(15%) were prostate cancer • 234(46%) were BPH with no other disorder • 196(39%) were BPH associated with inflammatory reaction Zabar K, Jalal A, Ebrahim M: Retrospective Analysis of Patients with lower Urinary Tract Symptoms due Benign Prostatic Hyperplasia, Bahrain Med. Bull, 28(4), 2006 Previous Studies- Bahrain

  13. A study on 1163 patients underwent TURP and prostate biopsies • 10.9% were diagnosed as having prostate cancer • Unfortunately, Prostatitis was not looked at as it was considered a clinical diagnosis Previous Studies -Oman George E., Thomas S.: A histo-pathological Survey of Prostate Disease in The Sultanate of Oman . The Internet Journal of Pathology 2005, vol.2, no.2

  14. Although the incidence of prostate cancer is low in Saudi Arabia, it usually takes place as high grade disease • Incidental prostate cancer detected in surgical specimens removed from clinically presumed benign disease is rising • Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5 rather than 4 ng/ml., otherwise we may miss a considerable number of our cancer patients Conclusions:

  15. Thank you

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