Elsevier

European Urology

Volume 43, Issue 2, February 2003, Pages 164-175
European Urology

Distribution of Inflammation, Pre-Malignant Lesions, Incidental Carcinoma in Histologically Confirmed Benign Prostatic Hyperplasia: A Retrospective Analysis

https://doi.org/10.1016/S0302-2838(02)00548-1Get rights and content

Abstract

Objectives: We analyze our experience on BPH through 20 years of histopathological examinations performed by the same pathologist.

Methods: We retrospectively reviewed all histopathological examinations performed from January 1979 to December 1998 in patients undergoing surgery in our urological clinic who were diagnosed with BPH. We limited our evaluation to the following variables in each BPH case analyzed: inflammatory aspects associated with BPH, presence of focal acinar atrophy, atypical adenomatous hyperplasia (AAH), prostatic intraepithelial neoplasia (PIN), incidental prostate carcinoma (IC). These histological variables were analyzed according to some clinical parameters such as age, prostate volume and serum PSA.

Results: The study population was comprised of 3942 cases with histological diagnosis of BPH. The mean patient age was 68.85±7.67 years. In particular, inflammatory aspects were associated with BPH in a high percentage of cases (43.1%=1700 cases), predominantly as chronic inflammation. Observation of focal acinar atrophy significantly increased according to patient decade of age (p=0.027). There was a significant trend to increase with age decades (p=0.036) for high grade PIN. A significant difference was found in IC (T1a, T1b) distribution in the different decades of age and especially in regards to both T1a and T1b tumors, there was a trend to increase with patient age (p=0.020 and p=0.025, respectively). On the contrary, the distribution of inflammatory aspects (p<0.001) and AAH (p=0.003) significantly varied according to prostate volume, and particularly in regards to chronic inflammation, there was a trend to increase depending on the prostate volume (p=0.002). Only the presence of T1b tumor but not of the other histological parameters associated to BPH, was able to significantly influence serum PSA.

Conclusion: In our analysis different histological variables associated to BPH are differently influenced by the age of patients and prostate volume, and they differently influence serum PSA levels.

Introduction

Clinical aspects of benign prostatic hyperplasia (BPH) are not necessarily related to the size of the prostate but may be correlated with the histological composition of its volume [1]. Histopathological analysis may, therefore, also have clinical and practice relevance. Histological examination of the prostate must also include the description of some important aspects which may be present or associated with BPH and which may condition the progression of this disease.

In this study, we focused our attention on the following variables analyzed during the histological examination for BPH: inflammatory aspects, lesions considered pre-neoplastic, and the incidental diagnosis of prostate cancer.

It is well recognized by both urologists and pathologists that BPH and inflammation can coexist [2], [3], but the interrelationship between BPH and prostatic inflammation, and how one may influence the presentation of the other, is unknown [4].

On the other hand, putative pre-malignant lesions of the prostate gland have been recognized for a long time, and they may be associated with the histological diagnosis of BPH. Early investigations have revealed that prostate carcinoma is often associated with focal glandular atrophy [5]. Other authors have reported that focal prostatic glandular atrophy may occur in association with chronic inflammation [6], [7]. Recent reports suggest that focal atrophy may be causally linked to prostate cancer and to other pre-neoplastic lesions [8]. However, autopsy studies of atrophy have rejected this concept, and data supporting reconsideration at this time are limited.

Atypical adenomatous hyperplasia (AAH) is another possible finding in the prostate that may be pre-malignant, but data on this lesion are much less convincing than data on prostatic intraepithelial neoplasia (PIN). Most cases of AAH are localized in the transition zone of the prostate [9], [10]. On the contrary, occurrence of PIN in transurethral resection of prostate specimens is relatively uncommon [11].

The present study cannot be considered an epidemiological analysis for it reports only our experience on BPH through 20 years of histopathological examinations performed by the same pathologist (ADM). We reviewed a large number of pathological specimens obtained at resection of the prostate for BPH in our clinic. In this initial study, we primarily focused our analysis to aspects of BPH obtained from histopathological examinations, but we also tried to compare these data with some clinical parameters such as age of the patient, prostate volume, total prostate specific antigen (PSA) serum levels.

Therefore, the aim of this study was to:

  • 1.

    analyze the distribution of inflammation, focal acinar atrophy, AAH, PIN, and IC in histologically confirmed BPH samples;

  • 2.

    analyze their changes in different periods of examination (from 1979 to 1998);

  • 3.

    analyze their relationships and their differences on the basis of classification of cases by patient age decade, prostate volume and surgical procedure;

  • 4.

    analyze their effect on serum PSA levels.

Section snippets

Materials and methods

This is a retrospective, single center study. We reviewed all histopathological examinations consecutively performed from 1979 to 1998 in patients undergoing surgery in our urology clinic who were diagnosed with BPH. All histopathological examinations were performed by the same pathologist (ADM), and in each case all histological slides were reviewed by two pathologists without their having any knowledge of the clinical course of the patients. Inclusion into this study was based on the

Results

Our analysis included 3942 histopathological examinations for BPH.

Table 1 summarizes data of the 3942 cases which satisfied the study criteria. In particular, inflammatory aspects were present in a high percentage (43.1%=1700 cases) of cases, predominantly as chronic inflammation. Inflammation was mild in 78%, moderate in 21%, and severe in only 1% of these 1700 cases.

PIN was present in 2.1% of our cases with similar distribution for LGPIN (1.1%) and HGPIN (1.0%).

Incidental carcinoma was found

Discussion

In this study we used the histopathological examinations performed by the same pathologist over a 20-year period to describe some aspects which can be associated with the histological diagnosis of BPH, in relation to clinical parameters such as patient age, prostate volume, and different periods of observation. Moreover we analyzed the influence of these different histological aspects on serum PSA levels.

The strengths of this study were the relatively large sample size and the standardized

References (43)

  • E.O. Odunjo et al.

    Chronic prostatitis in benign prostatic hyperplasia

    Br. J. Urol.

    (1971)
  • J.C. Nickel

    Prostatic inflammation in benign prostatic hyperplasia—the third component?

    Can. J. Urol.

    (1994)
  • J.C. Nickel et al.

    Asymptomatic inflammation and/or infection in benign prostatic hyperplasia

    Br. J. Urol.

    (1999)
  • C.J. Smith et al.

    Inflammation-proliferation: possible relationships in the prostate

    Prog. Clin. Biol. Res.

    (1987)
  • Bennett BD, Richardson PH, Gardner WA. Histopathology and cytology of prostatitis. In: Lepor H, Lawson RK, editors....
  • J.E. McNeal

    Normal histology of the prostate

    Am. J. Surg. Pathol.

    (1988)
  • B. Helpap et al.

    Relationship between atypical adenomatous hyperplasia, prostatic intraepithelial neoplasia and prostatic adenocarcinoma

    Pathologica

    (1997)
  • C.H. Bangma et al.

    Transurethral ultrasonic volumetry of the prostate in vivo comparison of different methods

    Prostate

    (1996)
  • Sobin LH, Wittekind CH, editors. TNM classification of malignant tumours. 5th ed. New York: Wiley; 1997. p....
  • D.G. Bostwick et al.

    Prostatic intraepithelial neoplasia and early invasion in prostate cancer

    Cancer

    (1987)
  • J.R. Drago et al.

    Introductory remarks and workshop summary

    Urology

    (1992)
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