Elsevier

European Urology

Volume 48, Issue 5, November 2005, Pages 739-744
European Urology

The Prevalence of Prostate Carcinoma and Its Precursor in Hungary: An Autopsy Study

https://doi.org/10.1016/j.eururo.2005.08.010Get rights and content

Abstract

Objectives:

The prevalence of incidental prostatic adenocarcinoma (PCa) and its precursor, high grade intraepithelial neoplasia (HGPIN) in an autopsy series from Hungarians (Central European Caucasians) was assessed and compared to similar data from the United States and European countries.

Methods:

Autopsy cases (n = 139; 18–95 years) with no history of urological disease were histologically examined for prostate cancer and HGPIN. After en block removal, the prostate glands were fixed in formalin, sectioned at 3–5 mm intervals and embedded in paraffin. Whole-mount serial sections were stained with Hematoxylin-eosin and examined for the presence of PCa and HGPIN. The frequency of PCa and HGPIN was compared to autopsy data obtained from other geographical areas.

Results:

We found a 38.8% prevalence of incidental PCa with increasing age-related incidence. Both PCa and HGPIN are first detected in the 3rd decade and show a steady increase with age with respect to number of foci, tumor grade and volume. In the age group 81–95, 86.6% and 60% of men had PCa and HGPIN, respectively.

Conclusions:

Incidental PCa and HGPIN are very prevalent in Hungarian population, comparable with the high US and the Scandinavian epidemiological data for Caucasians.

Introduction

Population-based studies have shown significant geographical differences in the incidence and the mortality of prostate cancer [1], [2], [3], [4]. For example, adenocarcinoma of the prostate gland (PCa) is the most frequent malignancy affecting males in the United States and Scandinavia, whereas its incidence and mortality rate among native Asian men living in their own countries are low [5], [6], [7], [8], [9]. Accurate prediction of prostate cancer prevalence and mortality, however, are hindered in some populations by the absence of relevant epidemiological data, including the frequency of clinically not diagnosed or incidental tumors. In some countries, efforts to identify prostate cancer prevalence focused on autopsy studies which identify the presence of unsuspected carcinoma in the prostate glands of men deceased from unrelated causes [10], [11], [12], [13], [14], [15], [16], [17]. These studies revealed a surprisingly high prevalence of premalignant (HGPIN) and maligant disease in young men, starting in the third and fourth decades of life, and increasing steadily thereafter [18]. This information has important implication for the design of early detection efforts and for disease prevention strategies. Independent investigators found that Japanese men also have a high prevalence of incidental prostate cancer, despite much lower clinical incidence and mortality [19]. In contrast, the prevalence of incidental PCa was recently found significantly lower in Caucasian Mediterraneans of Spain, though the incidence rate for clinical prostate cancer is higher than in Japanese population [20]. Such epidemiological studies have not been carried out in many other geographical areas including Hungary.

Hungary has one of the highest cancer incidence and mortality rates in the world and currently prostate cancer is the third most common malignancy [21], [22]. An earlier report, using cancer statistics from the period of 1970–1990, described an increasing mortality rate of prostate cancer as being the fourth most common cause of cancer-related death of men [23]. This increase, however, appears disproportionate to the incidence of manifest PCa: the annual reported death cases from prostate cancer are approximately 50% of the newly diagnosed PCa cases in Hungary [21], [24]. This death rate seems to be significantly high when compared to the 13–20% of the race-matched average annual mortality rate over the incidence in the United States and other regions [7], [25], [26]. The discrepancy between the mortality rate and the incidence found in Hungary may in part be due to underestimation of the true annual frequency of clinically manifest prostate cancers. On the other hand, the more advanced tumor at the time of diagnosis brings about more limitations in the treatment options leading to high death rate of PCa. Efforts to increase the diagnosis in a still curable stage are under way, and screening for early detection and chemoprevention are important public health concerns.

Successful achievement of these goals requires a thorough understanding of disease prevalence and epidemiology. The current study evaluates the prostates of men deceased of unrelated causes and autopsied at the University of Debrecen, Hungary. The autopsy study on 139 Hungarian cases has revealed a high prevalence of latent prostate carcinomas with increasing age-related incidence, comparable with the US and the Western European epidemiological data for Caucasians.

Section snippets

Material and methods

One hundred and forty two prostate glands were obtained during routine autopsy from men deceased with no history of urological disease and malignancy including prostate cancer. The men ranged from 18 to 95 years of age. The prostate glands were removed en-block with the seminal vesicles within 36 hours of death and placed in buffered formalin (pH7.3) for two to three days at room temperature. Each gland was sectioned at 3–5 mm intervals perpendicular to the posterior surface [14] and placed in

Results

Of 142 prostate glands obtained during autopsy, 71 (50%) were free of malignant or pre-malignant lesions. During the autopsy and microscopic evaluations of the 142 deceased males we noted one case each of primary small cell carcinoma of the prostate (32 y), ductal carcinoma of the prostate (72 y), and squamous cell carcinoma of the bladder extending into the prostate (61 y). Hence, these cases were omitted from the study since none of them were regular PCa. Of 139 remaining cases,

Discussion

Hungary leads the world in both the incidence and the mortality rate for various cancer types. Mortality from malignancy is the second most common cause of death in both sexes representing approximately a 25% frequency [21]. According to the data of the European Cancer Centre and the Hungarian National Cancer Registry, there are increasing case numbers in Hungary for the lung, laryngeal and the oral cavity cancers, and the colorectal tumors, pancreatic carcinomas, and leukemias have all been

Acknowledgement

Grant sponsor: NIH International Research Funds and the University of Debrecen.

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