Anterior-predominant Prostatic Tumors

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An38
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Date Joined Mar 2010
Total Posts : 1148
   Posted 8/31/2010 9:02 PM (GMT -6)   
Hello all,
 
I e-mailed the pathologist who did my husband's final pathology report as the grade 4 portion of his 3+4 diagnosis and the largest tumour was in the anterior fibromuscular area of the prostate (and I could not find much literature about cancers in this non-glandular fibromucular zone).
 
To my surprise he wrote back straight away and provided me a link to this great article which I actually bought. The abstract though is available for viewing.
 
 
It seems the anterior fibromuscular stroma is the first place that anterior cancers spread to from either the TZ or the PZ in fact the majority of anterior cancers do spread into this zone. Previously the fibromuscular stroma was considered to be a sort of barrier. This part of the prostate does not have a capsule so the other interesting thing defined in the article was was how extraprostatic extension is defined for people with anterior prostatic cancer.
 
This article may not be for everyone but it would be interesting for people with anterior zone cancers and could even contribute to the discussion on active survellence because anterior-predominant prostate cancers are difficult to diagnose through biopsy.
 
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)

Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4. Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.

Post Edited (An38) : 8/31/2010 9:39:37 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/31/2010 9:11 PM (GMT -6)   
Good find, An.

I have never even heard of this before, so I will chalk it up as my "I learned something new today" item. Thanks. Hope others will find it both useful and educational.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 8/31/2010 10:05 PM (GMT -6)   
An,
I have researched TZ tumors quite extensively and there is not a lot of information about them. A couple of things I found out.
1. They give off a large amount of psa for their size. PSAs of up to 300 have been recorded with the tumor still contained. (Dr Patric Walsh)
2. They are difficult to diagnos with a biopsy as most biopsy needles won't go that deep. I had 13 biopsies before my TZ tumor was discovered, and that was with a color doppler. I was actually showed the tracks of my previous biopsy and they went all around it.
3. TZ tumors are mostly contained as they are deep within the prostate and need to grow a lot before they reach the margin.
4. Surgery for TZ tumors is very difficult and the possibility of positive margins are very high because most surgeons don't get all the prostate tissue. (Dr Peter Scardino, Dr Duke Bahn, Dr Jelle Barantsz)
Hope this helps.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 8/31/2010 10:24 PM (GMT -6)   
Hi John,

The anterior fibromuscular zone is actually behind the transitional zone of the prostate. So it's even harder to biopsy than the transitional zone and you know how hard that was for you.

Anterior transitional zone cancers grow through the anterior fibromuscular zone to get to the margin and my previous understanding was that you needed to have a pretty significant TZ cancer before it started invading the fibromuscular zone and then the margin.Surprisingly, turns out from this article they have found that most anterior TZ and PZ cancers invade the fibromuscular zone.

My concern with Paul's RP report was that the anterior fibromuscular zone cancer existed without a significant transitional zone cancer in the pathology slice or in the pahology slice above or below the location of the fibromuscular zone cancer.  
 
1% of the RP cancers in their 1300 specimens were fibromuscular zone cancers with no obvious point of origin (and it looks like Paul's cancer fits into this catagory). It looks like the anterior margins are negative for Paul but 25% of this type of cancer is margin positive.

Regards,
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)

Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4. Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.

Post Edited (An38) : 8/31/2010 10:28:29 PM (GMT-6)


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 9/1/2010 12:44 AM (GMT -6)   
Hi Ann,
 
Thanks for sharing that one, certainly was not aware of that.  Fortuneately your husband, like myself chose the best surgeon in Australia - Dr Philip Stricker.  He has certainly has done me proud, and I am doing very well, coming up 2 years shortly.  Wishing you both well, and good luck with the first psa test
coming up...........................Kev
Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everday in Everyway, I get better"

Post Edited (NotHard) : 9/1/2010 12:56:57 AM (GMT-6)

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