Elsevier

Pathology

Volume 35, Issue 6, December 2003, Pages 467-471
Pathology

Transition zone carcinoma of the prostate gland: a common indolent tumour type that occasionally manifests aggressive behaviour

https://doi.org/10.1080/00313020310001619154Get rights and content

Summary

Aims

Tumours arising in the transition zone (TZ) of the prostate gland are often well differentiated and considered clinically unimportant. We have observed examples of high-grade TZ cancers that prompted this study.

Methods

Review of 654 radical prostatectomy specimens previously assessed by systematic whole organ histology identified 187 (29%) TZ cancers of which 76 (11.6%) represented the index (main) tumour. These were compared with a volume-matched group of 76 peripheral zone (PZ) carcinomas.

Results

Fifty-nine of 76 TZ index carcinomas had additional minor tumours mainly located in the PZ. Compared to PZ tumours of similar size, TZ tumours had significantly lower Gleason scores, less Gleason grade 4/5 and lower rates of capsular penetration and positive surgical margins. However, within this TZ tumour group, seven carcinomas had a major Gleason grade 4 or 5 component with high rates of capsular penetration (57%) and positive surgical margins (43%). Positive anterior and bladder neck margins were more common in TZ carcinoma than peripheral tumours and transperineal biopsy was the method of choice for TZ cancer diagnosis.

Conclusions

A subset of TZ carcinoma characterised by high tumour grade has a significant risk of extraprostatic spread, margin positivity and possible biochemical failure. We recommend transperineal prostate biopsy for TZ tumour diagnosis and histological sampling of the anterior TZ at radical prostatectomy, even if macroscopically normal, to detect patients at risk from aggressive TZ carcinoma.

References (25)

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    Index prostatic adenocarcinoma originating in the transition zone represents approximately 20% of all prostate cancer. Usually these tumors are detected when significantly larger than their peripheral zone (PZ) counterparts, yet have a more favorable prognosis that is attributed to their lower histological grade (2005 Gleason grading system) [1-7]. Biological differences between TZ carcinoma and PZ tumors, remain largely unknown but, transition zone tumors rarely gain access to the seminal vesicles, or posterolateral penetrating peripheral nerves.

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    The prostate gland consists of internal structures including the peripheral zone (PZ), central zone (CZ), and transition zone (TZ), where the latter 2 structures are jointly referred to as the central gland (CG) [17]. CG tumors have been found to be significantly less aggressive compared to PZ tumors [18] and the different zones can even have different tissue compositions [19], suggesting that they may respond to EBRT differently. Following EBRT, there can be a significant loss in visible zonal anatomy on MRI [20].

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