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OBJECTIVE As novel therapies improve survival for men with prostate cancer, intracranial metastatic disease has become more common. The purpose of this multicenter study was to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) in the management of intracranial prostate cancer metastases. METHODS Demographic data, primary tumor characteristics, SRS treatment parameters, and clinical and imaging follow-up data of patients from nine institutions treated with SRS from July 2005 to June 2020 for cerebral metastases from prostate carcinoma were collected and analyzed. RESULTS Forty-six patients were treated in 51 SRS procedures for 120 prostate cancer intracranial metastases. At SRS, the mean patient age was 68.04 ± 9.05 years, the mean time interval from prostate cancer diagnosis to SRS was 4.82 ± 4.89 years, and extracranial dissemination was noted in 34 (73.9%) patients. The median patient Karnofsky Performance Scale (KPS) score at SRS was 80, and neurological symptoms attributed to intracranial involvement were present prior to 39 (76%) SRS procedures. Single-fraction SRS was used in 49 procedures. Stereotactic radiotherapy using 6 Gy in five sessions was utilized in 2 procedures. The median margin dose was 18 (range 6–28) Gy, and the median tumor volume was 2.45 (range 0.04–45) ml. At a median radiological follow-up of 6 (range 0–156) months, local progression was seen with 14 lesions. The median survival following SRS was 15.18 months, and the 1-year overall intracranial progression-free survival was 44%. The KPS score at SRS was noted to be associated with improved overall (p = 0.02) and progression-free survival (p = 0.03). Age ≥ 65 years at SRS was associated with decreased overall survival (p = 0.04). There were no serious grade 3–5 toxicities noted. CONCLUSIONS SRS appears to be a safe, well-tolerated, and effective management option for patients with prostate cancer intracranial metastases.

Dural metastases originating from prostate cancer are exceedingly uncommon and may clinically imitate a subdural hematoma. Additionally, head computed tomography scan findings can be mistaken for meningioma or subdural hematoma. We present a 75-year-old male patient with dural metastasis as a first presenting sign of prostate cancer, misdiagnosed as a bilateral subdural hematoma on initial non-contrast brain CT scan. Also, a review of literature is presented. We found 12 cases of dural metastasis of prostate cancer mimicking subdural hematoma described in the literature, and unlike in our case, prostate cancer was already diagnosed.

Introduction: [177Lu]Lu-prostate-specific membrane antigen (PSMA)-617 has emerged as a promising radiopharmaceutical for targeting PSMA in metastatic castrate-resistant prostate carcinoma (mCRPC). ...

BACKGROUND Prostatitis caused by Brucella infection is rare and usually lacks typical lower urinary tract symptoms. However, Brucella infection can cause serum prostate-specific antigen levels to become abnormally elevated. When concurrent with lumbar vertebra infection and erosion, brucellosis can easily be misdiagnosed as prostate cancer with bone metastasis. CASE SUMMARY A 45-year-old man complained of recurrent low back pain and fever for 2 wk. Magnetic resonance imaging of the lumbar vertebrae showed abnormal signs at the rear of the L4–5 vertebral body. Serum prostate-specific antigen level was 17.64 ng/mL, and positron emission tomography/computed tomography suggested the possibility of prostate cancer with liver and lumbar metastases. The patient was transferred to our department for further treatment. He experienced repeated bouts of fever and low back pain during hospitalization. Biopsy results indicated prostatitis. There was no significant increase in white blood cell count or procalcitonin levels. The Mycobacterium tuberculosis smear and antibody detection results were negative. Cefoperazone sulbactam was not effective. Blood culture test results were positive for brucellosis, confirming the diagnosis of brucellosis. After oral anti-infection treatment with doxycycline and rifampicin, the body temperature gradually returned to normal, and lumbago improved. After continuous treatment for 6 mo, the patient recovered. CONCLUSION In patients with low back pain and fever accompanied by elevated prostate-specific antigen levels and lesions of the prostate and lumbar spine, a detailed medical history and blood and urine cultures should be obtained, and attention should be given to the local epidemic infectious disease situation.

Prostate carcinoma is typical cancer. It is the second most common cancer globally. The estimated new cases in 2020 was 191 930 and estimated deaths was 33 330. Age, family history, & genetic factors are major factors that drive prostate cancer. Although, for treating metastatic disease, the major therapies available are radiation,bisphosphonate, and palliative chemotherapy. But the major drawback is therapy is disease-driven and later becomes metastatic and requires treatment. The ability to revolutionize cancer treatment by major targeting vehicles via the exploration of nanoemulsion suggests a potential for cancer treatment. The unique property of a biphasic liquid dosage form called nanoemulsion to reach leaky tumor vasculature is due to its nano-meter oil-droplet size of 20–200 nm. Recent reporting on nanoemulsions disclose their embracing and lay alternative for re-purposing herbal and synthetic drugs and their combination especially for targeting prostate cancer formulating an obtainable nanomedicine. So, this article emphasizes the use of nanoemulsions incorporating therapeutic agents for successful and targeted delivery for prostate cancer.

Objective To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies. Material and methods Retrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values ( All patients were referred to 68 Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed. Results The 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them. Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL). One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. Conclusion 68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

Purpose To compare brachytherapy (BT) boost of low-dose-rate (LDR) and high-dose-rate (HDR) techniques in patients diagnosed with intermediate-risk prostate cancer. Material and methods Between January 2005 and February 2018, 142 patients (50 LDR and 92 HDR) with intermediate-risk prostate cancer were treated with a BT boost, and retrospectively analyzed. Prescribed dose was 45 Gy with external beam radiotherapy (EBRT) plus 100-108 Gy with LDR-BT, and 60 Gy with EBRT plus one fraction of 10 Gy with HDR-BT. 99% of patients received androgen deprivation therapy (ADT) for 6 months. Primary endpoint was to compare LDR and HDR boosts in terms of biochemical progression-free survival (bPFS). Secondary endpoint, after re-classifying patients into "favorable" and "unfavorable" sub-groups, was to analyze differences with a similar treatment intensity. Results Median overall follow-up for the total cohort was 66.5 months (range, 16-185 months). There were no significant differences in bPFS, overall survival, cause specific survival, local failure, lymph node failure, or distant failure when LDR or HDR was employed. bPFS at 90 months was 100% for favorable, and 89% and 85% for unfavorable patients at 60 months and 90 months, respectively (log-rank test, p = 0.017). The crude incidence of genitourinary acute and chronic toxicity grade 3 was 0.7% and 4%, respectively. Twelve patients (8%) had chronic rectal hemorrhage grade 2, in whom argon was applied (4 LDR and 8 HDR). Conclusions Combined treatment is an excellent therapeutic option in patients with intermediate-risk prostate carcinoma, with similar results in both LDR and HDR approaches and very low toxicities. Importantly, the current literature has indicated that unfavorable-risk patients belong to a different category, and should be treated as patients with high-risk factors. Therefore, the stratification and identification of both risk groups is extremely relevant.

Background: The purpose of this study was to determine the degree of alignment of prostate carcinoma in a rectal biopsy with radical prostatectomy in patients with prostate carcinoma to determine which biopsy samples are consistent with surgical specimens. Methods: In this cross-sectional study, out of 122 patients with prostate cancer who had undergone radical prostatectomy surgery in Sina hospital of Tabriz 65 patients with clinical records and pathological reports of needle biopsy, and radical prostatectomy biopsy specimens were available.The required information was recorded in questionnaire made for this study, and then the pathologic report and Gleason score and lymph-vascular involvement of the specimens were determined separately and finally the Trans rectal pathology report of the biopsy was compared with the histopathology report of radical prostatectomy in each patient. Results: The most common Gleason score and radical prostatectomy score were 6 (41.5%) and 6(40%), respectively. The lowest frequency of Gleason score, radical of the prostatectomy, and Trans rectal biopsy score were 10 (3.1%), 8(4.6%)%), and 4(4.6%), respectively. Generally, 24.6% of the prostatectomy samples were similarly scored, while 63.1% reported Trans rectal biopsy specimens and 12.3% reported low Trans rectal biopsy. By grouping the samples into histopathology levels this association was 41.5% identical in terms of scores and 49.2% in excess and 9.2% in lower reporting. The most common histopathology degree was rarely (49%) in Trans rectal biopsy and moderate in 40% in radical prostatectomy about 43% of badly differentiated cancers in the surgical specimens remained at the same level and the highest reporting rates were in the group with a good degree of distinction (66%). The highest correlation between rectal biopsy samples and radical prostatectomy samples was at the 6th grade and lowest compliance rate was in 4th and 8th grades. Conclusion: The highest degree of alignment was in the bad differentiation group, which indicates the high predictive power of biopsy specimens at this degree of differentiation. The present study suggests that the size of the smaller prostate and the high pre-surgical PSA may be predictive of increasing the Gleason score after radical prostatectomy.

Background: Transrectal needle biopsy of the prostate (TNBP) is a common urological procedure with some attendant infective complications. Although most urological surgeons give antibiotic prophylaxis, there is, however, no consensus on the duration. This study compares the outcome of a three-day and seven-day antibiotic prophylaxis in TNBP. Materials and Methods: One hundred and twenty men who met the inclusion criteria were recruited and randomized into two equal groups. The patients in Group I received oral ciprofloxacin and metronidazole for three days and Group II received the same drugs for seven days. The antibiotics were commenced 2 h before the biopsy. Urine samples were taken for microscopy, culture, and sensitivity before the biopsy in all patients. For patients in group I, urine microscopy, culture and sensitivity were done on days 5 and 10 after biopsy, and on days 10 and 14 after biopsy for group II patients. Infective complications were determined by the presence of fever and positive urine cultures post-biopsy. Results: This comparative prospective study was done between June 2016 and November 2017. Groups I and II had comparable infective complication rates (11.70% for Group I and 3.30% for Group II) (P = 0.212). However, diabetics did better on a seven-day regimen (P < 0.001). Escherichia coli was the most common organism isolated (63.2%). Cephalosporins were the most effective antibiotics in post-biopsy infections in this study. Conclusion: Three-day oral ciprofloxacin and metronidazole are effective for prophylaxis in TNBP. However, a seven-day regimen is better in diabetics before a prostate biopsy. The cephalosporins are a good option in the management of post-biopsy infections caused by quinolone-resistant organisms.

Background/Aim. Recent data imply the significance of certain cytokines in the appearance and development of prostate cancer (PC), as well as their association with pathohistological and/or clinical characteristics of PC. The aim of this study was to examine the relationship between the IL-10 concentration with histopathological and clinical characteristics of PC patients. Methods. IL-10 concentration was determined in serum, urine and prostate massage secret (pms) samples of 88 CP patients (initially and after therapy), 20 benign prostatic hyperplasia (BPH) patients and 15 healthy controls. Results. Compared to BPH and control groups, PC patients had the highest average serum IL-10 concentration. Interestingly, BPH patients demonstrated the highest concentration of IL-6 in urine and pms samples. Also, patients with G3 gradus and with the highest Gleason score (4 + 4) demonstrated the highest IL-10 serum level. PC patients without any histopathological sign of tumor invasion had a significantly increased serum IL-10, either before or after the therapy, compared to the patient group with evident invasion of tumor cells. The therapy induced different IL-10 profile in serum and urine samples. After the therapy, there was a clear significant IL-10 increase in serum of patients with unfavorable Gleason score (4 + 4), with present infiltration of tumor cells in peritumoral tissue (lymphatic, vascular and combined) and in patients with high tumor volume. Conclusion. PC patients without any histopathological signs of tumor invasion before the therapy have significantly increased serum IL-10 concentration compared to those with the signs of tumor invasion. There is a clear dissociation of IL-10 values between a serum sample and local, urine and pms samples from a particular patient. After the therapy, high IL-10 serum concentration is present only in patients with high Gleason score, pre-sent infiltration of peritumoral tissue and high tumor volume.

Diffuse peritoneal and omental infiltration of prostate cancer detected by 18F-PSMA-1007 PET/CT was rarely reported. We report a case of an 80-year-old man who was suspected of prostate carcinoma metastasis and underwent 18F-PSMA-1007 PET/CT for restaging the disease. PET/CT imaging presented intense tracer uptake in the prostate gland, multiple lymph nodes, and bones. Interestingly, we found extremely increased radioactive uptake of diffuse peritoneum and omentum on 18F-PSMA-1007 PET/CT images, which are very rare metastatic sites for prostate cancer.

Objectives: This study aimed to assess the incidence and discern the histomorphological spectrum of granulomatous prostatitis. Methods: A retrospective analysis of histopathological records of 1773 prostatic specimens received in the pathology department was done over a period of seven years. All histologically proven cases of granulomatous prostatitis were retrieved, the relevant clinical data were collected from patient records and the lesions were categorized accordingly. Results: Out of 1773 cases, 27 cases of granulomatous prostatitis were identified. The age range of these patients was between 50 and 89 years. Among the patients, non-specific granulomatous prostatitis (NSGP) was the most common followed by tubercular prostatitis, post-surgical prostatitis and xanthogranulomatous prostatitis. Three cases of post-surgical prostatitis were associated with malignancy. Serum prostate-specific antigen (PSA) levels ranged between 0.8 and 20.94 ng/mL (median 10.78 ng/mL). The diagnosis was made by histopathological examination of transrectal ultrasound (TRUS)-guided core biopsies, Trucut biopsies, transuretheral resection of prostate chips, prostatectomy and cystoprostatectomy specimens. Conclusion: In the present study, the incidence of granulomatous prostatitis was 1.5%. The patients usually present as hard nodules on digital rectal examination along with raised serum PSA levels. Carcinoma or benign prostatic hyperplasia was kept as a clinical diagnosis in these cases. Since the diagnosis of granulomatous prostatitis is made on histopathological examination only, meticulous histomorphological assessment is therefore required to reach a definitive diagnosis of granulomatous prostatitis.

Background/aim To compare the predictive efficacy of National Comprehensive Cancer Network (NCCN) and European Association of Urology (EAU) risk stratification systems in radiotherapy of prostate cancer. Patients and methods One-thousand-nine-hundred-nine patients treated with definitive (1,074), adjuvant (381), and salvage radiotherapy (454) were analysed. Results Both systems significantly predicted biochemical-relapse-free-survival, metastasis-free-survival, and disease-free-survival, while only the NCCN system correlated with local-control in the definitive radiotherapy group. In the adjuvant setting, both systems failed to predict all outcomes. In the salvage setting, only the NCCN system significantly predicted biochemical-relapse-free-survival, metastasis-free-survival and disease-free-survival. Conclusion This analysis confirms the efficacy of both systems in definitive radiotherapy and suggests the utility of the NCCN also in salvage radiotherapy.

ZusammenfassungDie radikale Prostatektomie (RP) als offener, laparoskopischer oder robotergestützter Eingriff stellt nach wie vor den kurativen „Goldstandard“ für Patienten mit einem lokal begrenzten Prostatakarzinom dar. Heutzutage wird die RP zudem als Erstbehandlung für ein lokal fortgeschrittenes Prostatakarzinom, eventuell im Rahmen eines multimodalen Settings mit adjuvanter Strahlen-/Hormontherapie angewendet. Die zunehmende Erfahrung der Chirurgen, die bessere Kenntnis der Anatomie und die Verfeinerungen der Operationstechniken haben die onkologischen sowie funktionellen Ergebnisse immens verbessert. In unserem Artikel möchten wir einen Überblick über die mit der Operation verbundenen Komplikationen geben.

Objective:Incidental early-stage prostate cancer (PC) can be detected in patients undergoing transurethral resection of the prostate (TURP) due to benign prostatic hyperplasia (BPH). In our study, we investigated the incidence of incidental PC and the relationship of the incidence of PC with age, serum prostate specific antigen (PSA) levels and resected prostate tissue volume in patients undergoing TURP for BPH.Materials and Methods:A total of 391 patients, who underwent TURP for BPH in our hospital between 2011 and 2018, were included in the study. Age and volumes of resection materials of the cases were obtained from pathology reports and blood PSA levels were obtained from the urology clinic.Results:In our series, incidental PC was detected in 17 of 391 cases (4.3%). The mean age of the patients with and without tumor was 74.5 years 69.5 years, respectively. The mean preoperative PSA level was 5.05 ng/mL in 226 patients without PC and the mean preoperative PSA level was 4.46 ng/mL in 15 patients with PC whose preoperative PSA levels could be checked by the urology clinic.Conclusion:In our study, incidental PC detection rate (

Though it is thousands of years old, prostate cancer (PCa) has only been known for 200 years. Until about 50 years ago, the diagnosis could only be made by digital rectal examination. Although the first prostate biopsies were already implemented in the beginning of the last century, it only obtained importance with the introduction of prostate-specific antigen (PSA) testing in the early screening for PCa and the pathologist, thus, became an essential partner for the urologist. In more recent years, specific MRI has significantly increased the accuracy of prostate biopsies. Thus, the question arises whether this technique is going to be so meaningful one day that prostate biopsy and the associated pretherapeutic histology are going to be redundant.

Purpose In recurrent prostate carcinoma, determination of the site of recurrence is crucial to guide personalized therapy. In contrast to prostate-specific membrane antigen (PSMA)–positron emission tomography (PET) imaging, computed tomography (CT) has only limited capacity to detect lymph node metastases (LNM). We sought to develop a CT-based radiomic model to predict LNM status using a PSMA radioguided surgery (RGS) cohort with histological confirmation of all suspected lymph nodes (LNs). Methods Eighty patients that received RGS for resection of PSMA PET/CT-positive LNMs were analyzed. Forty-seven patients (87 LNs) that received inhouse imaging were used as training cohort. Thirty-three patients (62 LNs) that received external imaging were used as testing cohort. As gold standard, histological confirmation was available for all LNs. After preprocessing, 156 radiomic features analyzing texture, shape, intensity, and local binary patterns (LBP) were extracted. The least absolute shrinkage and selection operator (radiomic models) and logistic regression (conventional parameters) were used for modeling. Results Texture and shape features were largely correlated to LN volume. A combined radiomic model achieved the best predictive performance with a testing-AUC of 0.95. LBP features showed the highest contribution to model performance. This model significantly outperformed all conventional CT parameters including LN short diameter (AUC 0.84), LN volume (AUC 0.80), and an expert rating (AUC 0.67). In lymph node–specific decision curve analysis, there was a clinical net benefit above LN short diameter. Conclusion The best radiomic model outperformed conventional measures for detection of LNM demonstrating an incremental value of radiomic features.

Background Disturbance in cell cycle regulatory genes is a common finding among many types of cancers. The aim of this study is to evaluate the role of cyclin D1 and DJ-1 in benign prostatic hyperplasia (BPH) and prostate cancer (PC). Method The current study enclosed 40 patients diagnosed with PC and 40 cases of BPH. The expression level of cyclin D1 and DJ-1 were evaluated by immunohistochemistry (IHC). Cyclin D1 scored depending on the percentage of stained nuclear tumor cells. While scoring of DJ-1 was based on intensity. The results were correlated with clinicopathological features and outcome. Results In the PC group, cyclin D1 was detected in 95% and overexpressed in 42.5%, DJ-1 was positively stained in 85% and overexpressed in 47.5%. Meanwhile, in the BPH group, cyclin D1 was not detected and DJ-1 stained in only 2.5%. There was a statistically significant difference in Gleason score (GS), tumor stage, size, and treatment failure (p =< 0.001). In the terms of PC diagnosis prediction, although cyclin D1 was more specific (100%), DJ-1 is more sensitive than cyclin D1 (80%, 70%, respectively) (p = 0.000). Conclusions Cyclin D1 and DJ-1 may emerge as a promising way for diagnosis of PC in certain circumstances, as the presence of insufficient tissue sampling, small foci of carcinoma or benign lesions mimic PC. This is in addition to the known role of cyclin D1 and DJ-1 in PC prognosis.

Dentre as inumeras condicoes de saude que acometem os homens, o carcinoma de penis e o carcinoma de prostata esta entre as neoplasias que requer uma atencao peculiar por parte dos profissionais de saude. Embora sejam duas doencas de proporcoes epidemiologicas diferentes, ambas possuem um impacto significativo no que se refere a saude da populacao masculina. Sendo o carcinoma de penis considerado uma neoplasia mais rara, tendo o equivalente a 1% dos casos de câncer para essa populacao, e considerado -tambem- caracteristico de paises subdesenvolvidos. Divergindo do câncer de penis em varios aspectos o carcinoma de prostata e uma neoplasia caracteristica de paises desenvolvidos sendo considerado uma condicao da populacao masculina idosa, com diversos fatores de risco diretamente ligados a sua incidencia. Esta pesquisa tem como objetivo contribuir com a identificacao dos impactos entre prevencao e diagnostico dos carcinomas de penis e prostata para populacao masculina. Tendo sido realizado um estudo de revisao de literatura nas bases de dados eletronicas Scientific Electronic Library Online (Scielo), EBSCO e Google Academico, onde foram utilizados artigos publicados entre os anos 2015 a 2020, em lingua portuguesa. Diante do exposto, concluiu-se que: nos resultados que as principais implicacoes para o diagnostico e tratamento precoce para os carcinomas de penis e prostata , e a dificuldade dos profissionais, especialmente da Atencao Primaria a Saude, na captacao do publico alvo em questao, observou-se tambem a baixa quantidade de materiais de pesquisa no que se refere ao carcinoma de penis, principalmente. O que aponta para uma maior necessidade de pesquisas a respeito do mesmo.

Introduction Carcinoma of the prostate is the most common malignancy among males. Serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE) are the initial investigations for the detection of prostate cancer. In recent years, some investigators have used color Doppler ultrasound and diffusion-weighted imaging (DWI) for the diagnosis of prostate cancer and avoided invasive and painful investigation, i.e., biopsy. The purpose of the study is to determine the validity of DWI in detecting prostatic cancer taking histopathology as the gold standard. Material and methods This cross-sectional study was conducted prospectively in the radiology department of a tertiary care hospital from January 1, 2019, to December 31, 2020. This study was approved by the Departmental Research Committee. A total of 272 male patients were included in our study who have elevated PSA levels (>4.0 ng/ml) with symptoms of hematuria and urinary retention. All included subjects were sent to the radiology department for DWI imaging. The DWI imaging was analyzed for prostate cancer and the results were correlated with histopathological diagnosis. Results The average age of patients was 50.28±9.93 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DWI in the diagnoses of prostate cancer were 86.7%, 87.8%, 75.8%, 93.8%, and 87.5%, respectively. Conclusion DWI is an informative and non-invasive imaging modality with high diagnostic accuracy for the diagnosis of prostate carcinoma.

Background Prostatic carcinoma is the commonest malignancy among men. It usually metastasizes to the spine and regional lymph nodes. However, it is extremely rare for it to metastasize to the mediastinum. Case presentation An elderly man presented to us with progressive onset of bilateral lower limb weakness which was associated with thoracic radiculopathy and urinary incontinence. An urgent magnetic resonance imaging (MRI) of the spine showed severe cord compression with enlarged prostate and superior mediastinal mass. A computed tomography (CT) guided biopsy of the mediastinal mass was suggestive of prostatic malignancy. An emergency posterior instrumentation and fusion (PSIF) in prone position was successfully done. Histopathological examination of the spine showed malignant glandular tissues, suggestive of prostate. Discussion A huge mediastinal mass can compromise the cardiorespiratory system and is very challenging for the anaesthetist to safely secure the airway for surgical procedures. Androgen deprivation therapy (ADT) for patients with metastatic prostatic carcinoma can be achieved either by medical castration or with bilateral orchidectomy. Conclusion It is extremely uncommon for a prostatic carcinoma to metastasize to the mediastinum. Patients with a huge mediastinal mass possess risks of cardiorespiratory collapse perioperatively. Chemoradiotherapy and androgen deprivation therapy (ADT) can be utilized for metastatic prostatic carcinoma with good outcomes., Highlights • Distant metastasis to the mediastinum is extremely rare. • Patients with a huge mediastinal mass are at risks of cardiorespiratory collapse. • Anaesthesia for patients with a huge mediastinal mass in prone position carries significant risks. • Androgen deprivation therapy (ADT) for patients with metastatic prostatic carcinoma can be achieved either by medical or surgical castration.

Despite the fact that prostate cancer is the most prevalent cancer in men, metastases to the central nervous system including leptomeningeal involvement by prostate carcinoma is a rare event. The prognosis of metastatic prostate cancer is very poor due to lack of CNS penetrating therapeutic agents., Despite the fact that prostate cancer is the most prevalent cancer in men, metastases to the central nervous system including leptomeningeal involvement by prostate carcinoma are a rare event. The prognosis of metastatic prostate cancer is very poor due to lack of CNS penetrating therapeutic agents.

A 68-year-old man underwent 18F-prostate-specific membrane antigen (PSMA) PET/CT for staging of a newly diagnosed prostate adenocarcinoma. Unexpectedly, PET/CT revealed high focal 18F-PSMA brain uptake, which initially was suspected for a brain metastasis. Corresponding CT and MRI scans revealed characteristic imaging features of an intracranial dermoid cyst at this site. This is an exceptional location for a dermoid cyst, which had been followed up conservatively with no substantial changes. This case shows that dermoid cyst should be added to the reported list of benign neoplasms that shows "false-positive" PSMA uptake during evaluation of patients with prostate carcinoma, representing a potential interpretative pitfall.

Background chronic lymphocytic leukemia (CLL) patients have a high risk of occurrence of secondary cancers. This risk is three times higher for all cancers and eight times higher for skin cancer. The coexistence of CLL and adenocarcinoma of the prostate is rare. Case presentation We report a case of a66-year-old man who underwent radical prostatectomy for prostate carcinoma. The final histopathological diagnosis of Gleason 7 adenocarcinoma of the prostate with incidental Rai stage I chronic lymphocytic leukemia (CLL) was made. No further investigations or treatment was offered due to the age and low disease stage. At the last follow-up of 12 months, the patient is alive, without disease progression for both lymphoma and prostate, with a PSA value of 0.03 ng/ml. Conclusion Early detection of lymphoma after radical prostatectomy will allow optimal management. The analysis of this link requires, therefore, additional investigations., Highlights • Chronic lymphocytic leukemia (CLL) patients have a high risk of occurrence of secondary cancers. This risk is three times higher for all cancers and eight times higher for skin cancer. • The coexistence of CLL and adenocarcinoma of the prostate is rare. • Early detection of lymphoma after radical prostatectomy will allow optimal management.

The majority of prostate cancer cases carry a favorable prognosis due to various screening protocols and the progression of surgical/medical techniques. Prostate cancers that metastasize to the skeletal system bear worse five-year survival rates as they are indicative of widespread dissemination. There are very few cases of prostate cancer invading the iliopsoas muscle described in the medical literature. Here, we present the case of a 61-year-old male who was diagnosed with prostate cancer with metastasis to the bones and iliopsoas muscle. Given the advanced presentation of his disease, the patient underwent a prostate biopsy. He was initiated on bicalutamide and transitioned to leuprolide and docetaxel with eventual radiation therapy.

Multiparametric magnetic resonance imaging (MRI) of the prostate has become a vital imaging tool in daily radiological practice for the stratification of the risk of prostate cancer. There has been a recent update to the Prostate Imaging-Reporting and Data System (PIRADS). The updated changes in PI-RADS, which is version 2.1, have been described with information pertaining to the recommended imaging protocols, the techniques on how to perform prostate MRI and a simplified approach to interpreting and reporting MRI of the prostate. Explanatory tables, schematic diagrams and key representative images have been used to provide the reader with a useful approach to interpreting and then stratifying lesions in the four anatomical zones of the prostate gland. The intention of this article is to address challenges of interpretation and reporting of prostate lesions in daily practice.&nbsp

Prostate cancer is a malignant disease of the urogenital system, which is the second most common cancer in men and one of the leading causes of death in male population. In Bandung City, Indonesia, no data are available regarding the profile of prostate cancer patients. This study aimed to determine the profile of prostate cancer patients treated at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, which is the tertiary hospital in the most populated province in Indonesia, during the period of 2015-2019. This was a a retrospective descriptive study on secondary data from medical records. Results showed that most prostate carcinoma patients were was 67.95 ± 8.946 years old with most of them (n=92, 81.4%) had a history of hypertension and 62 patients (54.9%) did not have any history of smoking. Most patients had 20-40 cc prostate volume with hard consistency and without nodules; a PSA level of > 20 ng/ml; and a gleason score of 8-10 or poorly differentitated. Age affected increased incidence of prostate carcinoma with the highes prostate volume (20-40cc). The average PSA was 504.66 ± 10.26 and the median gleason score was 8 (6-10). The highest prostate volume is 20-40cc with hard consistency without nodule and the highest PSA value is > 20 ng/ml with a Gleason score of 8-10, showing a poorly differentiated condition.

Objectives To determine the correlation of p53 expression with Gleason score in prostate cancer. Study design Descriptive study. Place and duration of study Department of Pathology, Fatima Memorial Hospital, Lahore; from January 2014 to August 2016. Methodology Thirty-seven samples of prostate carcinoma were graded using Gleason grading system. p53 expression was detected through routine immunohistochemical staining protocols and assessed semi-quantitatively using four-point scale score. The collected data was analysed statistically using Pearson's correlation coefficient. Results: Out of a sample of 37, high grade tumours were observed in 21 (57%) cases, making them the most prevalent type; while, p53 positive nuclear staining was observed in 26 (70%) cases. Within the high grade tumours, strong positive p53 expression was observed in 8 (38%) tumours; while, overexpression of p53 protein was seen in 7 (33%) cases. In contrast, overexpression of p53 was absent in low grade tumours. Conclusion A statistically significant correlation was observed between p53 positive expression and high Gleason grade. Key Words: Prostate cancer, Immunohistochemistry, p53 protein, Gleason score.

Tc-99m methylene diphosphonate bone scintigraphy (bone scan) is a highly sensitive technique for the evaluation of osseous pathology. However, the nonspecificity of the method can present diagnostic challenges in differentiating benign from malignant processes. Often, Paget's disease and osseous metastasis can coexist in elderly patients. Therefore, it is important to accurately distinguish the two pathologies, as each has a different prognosis and impacts clinical management. Obtaining the appropriate clinical diagnosis often involves a combination of laboratory, radiographic, and clinical data. We present a case of newly diagnosed prostatic carcinoma presenting with synchronous osseous metastasis, degenerative changes, and incidental multifocal Paget's disease.

Dorota Bartusik-Aebisher acknowledges support from the National Center of Science NCN (New drug delivery systems-MRI study, Grant OPUS-13 number 2017/25/B/ST4/02481).

Postoperative biochemical recurrence occurs in up to 40% of prostate carcinoma patients treated with radical prostatectomy. Primary tumor grade and cribriform architecture are important parameters for clinical outcome; however, their relevance at positive surgical margins has not been completely elucidated yet. We reviewed 835 radical prostatectomy specimens and recorded pT-stage, surgical margin status, Grade Group, and cribriform architecture of the primary tumor and at positive surgical margins. Clinicopathologic parameters and biochemical recurrence-free survival (BCRFS) were used as endpoints. Positive surgical margins were present in 284 (34%) patients, with a median cumulative length of 5.0 mm. In 46%, the Grade Group at the margin was equal to the primary tumor grade, while being lower in 42% and higher in 12%. In multivariable analysis, Grade Group at the margin outperformed the Grade Group of the primary tumor in predicting BCRFS. Among primary Grade Group 2 patients, 56% had Grade Group 1 disease at the margin. Multivariable analysis identified cumulative length, Grade Group at the margin, and lymph node metastasis as independent predictors for BCRFS, while percentage Gleason pattern 4, tertiary Gleason pattern 5 of the primary tumor, and cribriform architecture at the margin were not. In conclusion, the Grade Group at the positive surgical margin was dissimilar to the primary tumor grade in 54% and better predicted BCRFS than the primary tumor grade. Cumulative length and tumor grade at the margin were independent predictors for BCRFS, whereas cribriform architecture at the margin was not.

Zusammenfassung Gegenstand und Ziel In der Literatur konnte in 80 % der Bioptate kaniner Prostatakarzinome (PCa) die BRAF-Mutation nachgewiesen werden. Ziele dieser Arbeit waren, kanine Prostataproben aus dem eigenen Tiergut hinsichtlich des Auftretens der BRAF-Mutation zu untersuchen sowie die Spezifität und Sensitivität des Tests zu evaluieren. Außerdem sollte die Methodik für zytologische Ausstriche etabliert und die Korrelation zwischen der BRAF-Mutation und dem histologischen Bild kaniner PCa dargestellt werden. Material und Methoden Bioptate (n = 70) und Feinnadelaspirate (n = 17) der Prostata von 87 Hunden wurden histologisch oder zytologisch untersucht. Die Einteilung der Erkrankungen erfolgte wie in der Literatur beschrieben in benigne Prostatahyperplasie (BPH, n = 22), Prostatitis (n = 14), Plattenepithelmetaplasie (PM, n = 2), Atrophie nach Kastration (n = 3) und PCa (n = 46; davon zytologisch nachgewiesen n = 11). Für die PCa wurde der Gleason-Score ermittelt. Zur DNA-Isolierung dienten kommerzielle Testkits. Das Exon 15 wurde mit dem TaqMan® SNP Assay untersucht. Die Spezifität und Sensitivität des Tests wurden berechnet. Ergebnisse Ein Gleason-Score von 6 und 7 ergab sich in je einem Fall, von 8 bis 10 bei 33 der PCa. Aus allen Proben ließ sich ausreichend DNA isolieren. Die BRAF-Mutation war in 28/46 PCa nachweisbar (Sensitivität 61 %). Bei keinem Hund mit BPH, Prostatitis, PM oder Atrophie wurde die BRAF-Mutation festgestellt (Spezifität 100 %). Durch die BRAF-Mutation verursachte PCa wiesen einen signifikant (p = 0,002) höheren Gleason-Score auf als PCa ohne diese Mutation. Schlussfolgerung und klinische Relevanz Die Untersuchung auf das Vorliegen der BRAF-Variante V595E ist ein hochspezifisches Verfahren, mit dem sich in histologisch und zytologisch fraglichen Fällen die Verdachtsdiagnose eines PCa absichern lässt. Durch die BRAF-Mutation verursachte PCa zeigen histologisch stärker ausgeprägte Malignitätskriterien als nicht durch diese Mutation bedingte. Die klinische, therapeutische und prognostische Relevanz dieser Befunde bedarf weiterer Studien.

Aims and Objective: In recent period, basal cell markers high molecular weight cytokeratin (HMWCK), P63 and prostate biomarker AMACR have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity. Materials and Methods: In this prospective study, total of 80 cases including 40 cases of malignant lesions and 40 cases of benign lesions of the prostate were taken. Tumor grade was determined according to Gleason's grading system. AMACR, HMWCK, P63 expressions were determined by immunohistochemical staining. Results: This study showed AMACR had a sensitivity of 90%, specificity of 100%. AMACR was not expressed in any of the 40 cases of benign lesions of the prostate while in malignant lesions of prostate it was expressed in 36 of 40 (90%) cases; 15 of 16 (93%) of well-differentiated carcinoma were positive for AMACR expression; 17 of 19 (89.47%) moderately differentiated and 4 of 5 (80%) cases of poorly differentiated tumors were positive for AMACR. There was statistically significant difference in expression of AMACR between benign and malignant lesions of the prostate (P = 0.001). In benign lesions, HMWCK and P63 were expressed in all the 40 (100%) cases, while in malignant lesions of prostate it was not expressed in any of the (0%) case. AMACR expression was not seen in any of the benign lesion. Out of 40 malignant cases, 4 cases were negative for AMACR, HMWCK and P63, 36 cases were positive only for AMACR, but no case was positive for HMWCK and P63. Conclusions: As an adjunct to biopsy, AMACR, HMWCK and P63 have potential for combating diagnostically challenging cases.

The International Collaboration on Cancer Reporting (ICCR) was formed in 2011 to harmonise the datasets, protocols and checklists for pathological reporting of various cancers and develop internationally agreed upon, evidence-based datasets. A dataset for prostate cancer in radical prostatectomy specimens was developed in 2011-2012 as part of a pilot project; however, it required substantial revision following the ISUP Consensus Conference on Gleason Grading in 2014, the publication of the World Health Organisation (WHO) Classification of Tumours of the Urinary System and Male Genital Organs in 2016, and the 8th edition of the Tumour-Node-Metastasis (TNM) staging system in late 2016. This article presents the up-to-date, evidence-based ICCR dataset and associated commentary for reporting prostate cancer in radical prostatectomy specimens. PubMed and Google search engines were used to review the published literature on the subject, and the dataset was developed in line with the previously published ICCR framework for the development of cancer datasets. Substantial changes have been incorporated into the second edition of the ICCR prostate cancer (radical prostatectomy) dataset. These include revisions to prostate cancer grading, reporting of intraductal carcinoma of prostate and surgical margins, among others. Up-to-date cancer datasets underpin structured reporting and facilitate the production of consistent and accurate pathological data for patient care as well as comparisons between different cohorts and populations internationally.

Intraductal carcinoma of the prostate is an adverse prognosticator of prostate cancer. However, the roles of proportion and architectural patterns of intraductal prostate carcinoma in patient outcomes remain unclear.We retrospectively analyzed data on 644 patients with de novo metastatic prostate cancer between 2010 and 2017. Intraductal carcinoma of the prostate was identified from 12-core prostate biopsy. We calculated the proportion of intraductal prostate carcinoma and identified patterns according to the 2016 WHO classification. Propensity score matching was performed to balance baseline characteristics between patients with and without intraductal prostate carcinoma. Kaplan-Meier curves and Cox regression were used for survival analyses. The end points were castration resistant prostate cancer-free survival and overall survival.Of the 644 patients 180 (28.0%) harbored intraductal carcinoma of the prostate. A 10% or greater incidence of the carcinoma was independently associated with worse prognosis (castration resistant prostate cancer-free survival HR 2.06, 95% CI 1.51-2.81, p0.001, and overall survival HR 2.52, 95% CI 1.52-4.16, p0.001), as was pattern 2 intraductal carcinoma of the prostate (HR 1.86, 95% CI 1.40-2.49, p0.001, and HR 2.12, 95% CI 1.29-3.46, p = 0.003, respectively). Based on these 2 risk factors all men were classified into 5 groups. Patients in group 0 (no intraductal carcinoma of the prostate) and prostate intraductal carcinoma group 1 (less than 10% intraductal carcinoma, pattern 1) had favorable median castration resistant prostate cancer-free survival (18.0 vs 16.9 months, p = 0.871) and median overall survival (neither reached, p = 0.698). Men in intraductal carcinoma of the prostate group 4 (10% or greater intraductal carcinoma, pattern 2) harbored the worst outcomes (median castration resistant prostate cancer-free and overall survival 8.4 and 29.9 months, respectively). Group 2 (less than 10% intraductal carcinoma, pattern 2, with median castration resistant prostate cancer-free and overall survival 14.2 and 45.9 months) and group 3 (10% or less prostate intraductal carcinoma, pattern 1, with median castration resistant prostate cancer-free and overall survival 11.9 and 39.7 months, respectively) had an intermediate prognosis.A 10% or greater proportion of intraductal carcinoma of the prostate and pattern 2 were 2 unfavorable prognosticators of metastatic prostate cancer. Pathological reporting criteria based on intraductal carcinoma of the prostate could improve the prediction of patient outcomes and optimize treatment decisions.

Background and objective Adenocarcinoma of the prostate is the second most common cause of cancer. The loss of CD10 is a common early event in human prostate cancer and is seen in lower Gleason Score malignancies while increased and altered expression is seen in high Gleason Score tumors, lymph nodes and bone metastasis. Material and methods This was a prospective observational study conducted on 75 patients suspected to have prostate cancer. Immunohistochemical profile was assessed for PSA, AMACR and CD10 immunostaining. The intensity of CD10 expression and pattern of CD10 staining of tumor cells was evaluated. Results The patients were in age group of 50-90 years with a mean age of 70.97 ± 9.51 years. As the Grade Group/Gleason Score increased, the number of cases showing negative expression decreased and the pattern of expression changed from membranous to cytoplasmic to both types of expression. As the serum PSA levels increased the intensity of expression changed from focally positive to diffusely positive. The pattern of expression also changed from membranous to cytoplasmic to both (membranous + cytoplasmic) types of expression with an increase in PSA levels. Conclusion By immunohistochemical analysis we can identify CD10 positive tumors, which may warrant more aggressive initial therapy. A number of drugs against CD10 are available based on which potential targeted therapies could be formulated.

Prostate carcinoma is one of the most common tumors worldwide. Histological confirmation by biopsy is an obligatory part of the diagnostic approach. The main problem of the 10-12-fold transrectal ultrasound-guided (TRUS) biopsy, which has so far been regarded as the gold standard, is the underdiagnosis of clinically significant cancer. MRI-based procedures, so-called fusion biopsies, have shown superior results when compared to conventional biopsies. There are three different approaches (cognitive and software-based MRI/TRUS fusion and in-bore biopsy) with comparable detection rates but differences in the technical aspects and time involvement. In order to reduce fusion errors, targeted biopsies should consist of multiple cores. There is currently no clear preference for the access pathway (transrectal or transperineal), but clinical parameters such as infection risk or location of the tumor can influence the decision. While the German S3 guideline considers MRI prior to primary biopsy to be optional, the 2019 European Association of Urology guidelines already recommend MRI prior to biopsy for all patients. The combination of MRI-targeted and systematic biopsy offers the highest detection rates with the disadvantage that more low-risk tumors are diagnosed. Both the patient and the urologist benefit from an improved informative value of the biopsy when deciding on active surveillance as well as when planning invasive therapies.

Introduction Majority of the elderly male population suffers from prostatism due to enlargement of the prostate as a result of what is now regarded as male climacteric. For standardizing multiparametric magnetic resonance imaging (MRI) of the prostate, the European Society of Urogenital Radiology published Prostate Imaging Reporting and Data System (PI-RADS) in 2012. Magnetic resonance spectroscopic imaging (MRSI) uses a strong magnetic field to obtain metabolic information that identifies the relative concentrations of various metabolites in the cell cytoplasm and the extracellular space. Prostate carcinoma is associated with proportionately lower levels of citrate and higher levels of choline and creatine than are seen in benign prostatic hyperplasia (BPH) or in normal prostate. This difference can be detected by MRSI. Aim This study has been undertaken with the objective of finding how reliable MRI is in establishing the diagnosis of lesions of prostate and to correlate the histopathological (HPE) findings of transrectal ultrasound (TRUS)–guided targeted prostate biopsy with the PI-RADS scoring (Version 2) on MRI in patients. Also, the study evaluates the accuracy of MRSI in the detection of prostatic carcinoma in men with elevated prostate-specific antigen (PSA) levels. Materials and Methods A prospective study was undertaken at a tertiary care hospital during a period of 2 years from May 2017 to April 2019 on 50 patients with PSA > 4 ng/dL and with palpable lesion on digital rectal examination. MRI and MRSI were performed with a 1.5-Tesla body MRI system. The pelvic phased-array coil was used for both excitation and signal reception. Imaging was done using standard protocols. Histological material was obtained from prostate chippings from transurethral resection of prostate. Results Fifty patients with elevated PSA levels underwent MRI, MRSI, TRUS-guided biopsy and documented PI-RADS scores. Eight patients had PI-RADS 1 score, 2 patients had PI-RADS 2 score, 8 patients had PI-RADS 3 score, 14 patients had PI-RAD 4 score, and 18 patients had PI-RADS 5 score. Thirty-two patients with PI-RADS 4 and PI-RADS 5 on imaging showed positive for malignancy on HPE, showing significant association on Chi-square test with X2 = 16.412 and p < 0.001 (statistically significant). MRSI detected 36 patients on biopsy proven cases of carcinoma (sensitivity 89.5%, specificity 64%, and accuracy 88%). Conclusion This study showed a very good correlation between positivity of prostate carcinoma on HPE and higher PI-RADS (4 and 5, respectively). PI-RADS overall score had 94% sensitivity compared with components such as diffusion-weighted imaging (DWI, 78%) and T2 hypointensity (72%). MRSI is more sensitive and specific compared with T2-weighted images alone.

The differential diagnosis between high-grade prostate carcinoma and infiltrating urothelial carcinoma (UC) in transurethral resection prostate specimens as well as cystoprostatectomy specimens may often be challenging due to morphologic and clinical overlap of the 2 entities. Such distinction has critical therapeutic and staging consequences, yet it is hampered by both issues in morphology and by the low accuracy rates of single immunohistochemical markers, as reported in literature. This review aims to provide a comprehensive analysis of the available morphological and immunohistochemical parameters, which may allow to discriminate between prostate carcinoma and urothelial carcinoma in the proper clinical context and to discuss their diagnostic applications in daily practice.

Introduction: In development of cancer chronic inflammation plays a major role. Most established determinants of Prostate Carcinoma (PCa) are modern life style genetics, and age. In the first prostate biopsy, approximately 1 out 5 men i.e., 20% with PCa may be misdiagnosed. Therefore, there is clear requirement of novel markers, which can detect both clinically significant PCa, and prevent unnecessary biopsy. Some solid tumours found to have association of Neutrophil to Lymphocyte Ratio (NLR), Platelate to Lymphocyte Ratio (PLR) and Red-cell Distribution Width (RDW).Aim: Aim of this study was to scrutinise the significance of association of Prostate Specific Antigen (PSA), PLR, NLR and RDW with PCa. Materials and Methods: This study was conducted using the cross-sectional method in the Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan between Jan 2018 to Nov 2020. In this cross-sectional study 84 patients who underwent Tran Rectal Ultrasound (TRUS) guided were included. Complete Blood Count (CBC) was used to determine PLR, NLR and RDW and biochemical test for PSA. Patients were divided into two groups; having benign and malignant pathology. Unpaired t-test, Mann-whitney U test, logistic regression analysis and correlation were performed for statistical analysis. Results: With the use of univariate logistic regression, association between PSA, NLR, PLR, RDW values and PCa detection was determined. We found that serum PSA was significantly more in the PCa group (as BPH and prostatitis are both benign conditions so are kept in nonPCa group) compared to other two groups (p

Background: Mucinous prostate carcinoma (PCa) and signet-ring-cell PCa are two rare variants of prostate cancer, but the transformation of mucinous PCa into mucinous PCa with signet ring cells was extremely uncommon, little data of therapy was available. Case presentation: We reported such a case that a man was pathologically considered as mucinous PCa after receiving transurethral resection of the prostate, then he underwent robotic-assisted laparoscopic radical prostatectomy (RARP), the pathological diagnosis was mucinous PCa (pT2cN0M0), without any adjuvant therapies, the man had received regular follow-up with serum total prostate-specific antigen level Conclusions: We reviewed the literatures and discussed the differential diagnosis, immunohistochemistry, prognosis of this rare carcinoma, emphasized the rarity of the histological change and demanded fundamental research clarifying the confusion of this change, which may be helpful to search for therapeutic targets and improve prognosis.

Locus minoris resistentiae refers to a region of decreased resistance within the body. This occurs from changes to the microenvironment secondary to previous trauma and results in increased vulnerability. As a result, infection, inflammatory processes, and malignancy may localize to this area. In this article, we describe 2 unique cases of malignancy, primary prostate carcinoma and serous carcinoma of the ovary, both of which disseminated to sites of prior trauma. We review the available literature, discuss proposed pathophysiology, and highlight the need for further investigations along with increased clinician awareness.

BACKGROUND: Gleason score (GS) is one of the stronger prognostic factors and is integral to the management of prostate carcinoma. Subsequent modifications, recommended by the International Society of Urological Pathology in 2005 and 2014, enabled accurate prediction of prognosis. The present study investigated GS variation trend of patients with prostate carcinoma from 1996 to 2019 and offered an overview of GS changes with age, specimen type, histopathological type and serum prostate specific antigen (PSA). METHODS: One thousand three hundred and seventy-six patients, admitted to Peking University People’s Hospital in 1996 to 2019, were divided into 1996 to 2006, 2007 to 2015 and 2016 to 2019 groups. Data, including demographic characteristics, GS, primary and secondary grade and percentage of primary and secondary grade of each group, were collected and analyzed. The population distribution and average of GS was evaluated, after segmented and stratified by age, type of specimen, histopathological type and PSA. RESULTS: The average of age and PSA of each cohort had no obvious change. The average of total GS fluctuated among three cohorts with statistically significant differences. The distribution of age and PSA did not differ among cohorts. The distribution of total and primary GS shifted, with more patients detected as total GS higher than 6 (86.1%), and more primary grade higher than 3 (56.7%) in 2016–2019. After segmented and stratified by age, specimen type, histological type and PSA, the population percentage of GS over 6 was significantly higher in 2016–2019 than 1996–2006 and 2007–2015 in patients aged younger than 80 years (age