Overview of Benign and Malignant Prostatic Disease in Pakistani Patients: A Clinical and Histopathological Perspective

Background: To present the overall clinical and histological perspective of benign and malignant prostaticdisease as seen in our practice in the Section of Histopathology, Department of Pathology and Microbiology,Aga Khan University Hospital, Karachi, Pakistan. Materials and
Methods: All consecutive prostate specimens(transurethral resection or TUR, enucleation, needle biopsies) received between July 1, 2012 and December 31,2012 were included in the study.
Results: Of the total of 785 cases, 621 (79.1%) were TUR specimens, 80 (10.2%)enucleation specimens, and 84 (10.7%) needle biopsies. Some 595 (75.8%) were benign, while 190 (24.2%) weremalignant. Mean weight of BPH specimens was 19 grams and 43 grams for TUR and enucleation specimensrespectively. Almost 67% of adenocarcinomas were detected on TUR or enucleation specimens. Of the abovecases, 41.7% were clinically benign while 58.3% were clinically malignant. The average volume of carcinoma inall cases ranged between 60 to 65%. The average number of cores involved in needle biopsies was 5. In general,higher Gleason scores were seen in TUR/enucleation specimens than in needle biopsies. Overall, in all types ofspecimens, commonest Gleason score was 7, seen in 74 (38.9%) cases, followed by Gleason score 9 seen in 47(24.7%) cases. Out of the 63 needle biopsies with carcinoma, radical prostatectomy was performed in 16 cases(25.4%).
Conclusions: Benign prostatic hyperplasia (BPH) is extremely common and constitutes the bulk ofprostate specimens. TMajority of prostatic carcinomas are still diagnosed on TUR or enucleation specimens.These included both clinically benign and clinically malignant cases. The volume of carcinoma in these specimenswas quite high indicating extensive disease. Gleason scores were also generally high compared with scores fromneedle biopsies. Commonest Gleason score in all type of specimens was 7. Pathologic staging was possible invery few cases since radical prostatectomies are rarely performed.