A unifying hypothesis that links benign prostatic hyperplasia and prostatic intraepithelial neoplasia with prostate cancer. Invited comments

The association between local atherosclerosis and prostate cancer

OBJECTIVE

To morphometrically compare local atherosclerotic changes in cancerous prostate with those in noncancerous prostate specimens, as epidemiological studies report a positive association between the prevalence of general atherosclerosis and prostate cancer.

MATERIALS AND METHODS

The intima-to-media-ratio (IMR) of 538 prostate capsular tissue arteries was measured in 50 prostate cancer-positive and 29 prostate cancer-negative specimens (including 26 with benign prostatic hyperplasia and three with normal prostatic tissue).

RESULTS

An IMR of >1 was significantly associated with prostate cancer and a greater risk of prostate cancer (odds ratio 2.28). The IMR was >1 in cancer-positive specimens about twice as often as in cancer-negative tissue.

CONCLUSION

Local atherosclerosis (measured by the IMR) was more pronounced in prostate cancer-positive than in prostate cancer-negative specimens. The results support the view that men with local atherosclerotic lesions are at higher risk of prostate cancer.

Prostatic intraepithelial neoplasia in prostate specimens: frequency, significance and relationship to the sampling of the specimen (a retrospective study of 121 cases)

OBJECTIVES

To determine the frequency of PIN (prostatic intraepithelial neoplasia) in prostate specimens and the relationship of PIN with PCA (prostatic carcinoma) and amount of sampling of the specimen.

MATERIALS AND METHODS

All the haematoxylin-eosin stained slides of 121 cases diagnosed between 1990 and 1995 were re-examined retrospectively. The amount of sampling of prostate specimens was also re-examined.

RESULTS

PIN was observed in 47.9% of all prostate specimens. The frequency of incidental PIN was 71.4% in cystoprostatectomy specimens. PIN was present in 58.3% of the cases with PCA. We observed foci of high-grade PIN adjacent to sites of invasive carcinoma in 100.0% of prostatectomy specimens with PCA. PIN was high-grade in 100.0% of the carcinomatous prostates with PIN. It was multifocal in 53.4% of 58 cases with PIN. Incidental PCA was identified in 14.3% of cytoprostatectomies for bladder cancer. The average number of paraffin blocks of prostatic tissue was 4.1 (+/-2.6) in cases with PIN and 3.2 (+/-1.4) in cases without PIN.

CONCLUSION

In prostate specimens, the determination of PIN is very important since it is the most likely precursor of PCA. The probability of detecting PIN and PCA in a prostate specimen is directly related to the amount of sampling.