The changes in prostate cancer and its management in the North West of England over a 10-year period

Objectives:

Our aim was to evaluate changes in prostate cancer diagnosis and management and to examine changes in the stage and grade of newly diagnosed prostate cancer in the North West of England over a 10-year period.

Materials and methods:

Data was collected concerning the diagnosis (including stage and grade) and management of newly diagnosed prostate cancer in the North West of England. There were three time points: 2003, 2007 and 2011 including a total of 648 patients. For assessment of median time changes Spearman’s Rank correlation test was used, for the assessment of changes in Gleason grade and clinical stage Mann–Whitney U test was used, and assessment of positive margin rates was done with Fisher’s test.

Results:

Median time from management decision to surgery has reduced from 46 (2003), 34 (2007) to 27 days (2011) ( p=0.074). The proportion of patients managed with active surveillance has remained relatively constant over time (18%, 16% and 21% respectively). More minimally invasive, nerve-sparing prostatectomies are now performed, and positive margin rates have significantly reduced from 53% (2003) to 23% (2011) ( p<0.001). Gleason grade significantly increased over time ( p<0.001); Gleason 7 disease was diagnosed in 23% of patients in 2003, 32% in 2007 and 49% in 2011 ( p<0.001). There was an increase in Gleason 8 disease; 6% (2003) to 8.6% (2011), but this was not significant ( p=0.27). Increase in clinical stage was also noted over time; identification of T3 disease rose from 2% (2003 and 2007) to 5% (2011) ( p=0.045) (excluding cases with non-recorded stage).

Conclusion:

Prostate cancer management in the North West of England has evolved over the last decade, with overall improvements in management quality. We have demonstrated an increase in the presenting stage and grade of prostate cancer over a 10-year period.

Ureteric stricture: an unusual presentation of metastatic prostate adenocarcinoma

We describe an unusual case of a prostatic adenocarcinoma presenting with a ureteric stricture secondary to a discrete metastatic lesion. A 76-year-old man presented with a short history of right loin pain. Initial examination was unremarkable, digital rectal examination was normal and prostate specific antigen was within normal range. Computed tomography showed right hydronephrosis and a distal ureteric stricture. A distal ureteric transitional cell carcinoma was thought to be most likely. A nephroureterectomy was carried out and histology revealed a skipped lesion of a metastatic prostate adenocarcinoma. Metastatic lesions to the ureters due to prostate cancer are rare. It was believed to be secondary to a transitional cell carcinoma as there was no evidence initially to suggest prostatic disease as the cause. A prostatic adenocarcinoma should be considered in the differential diagnosis of any lesions in the ureter believed to have a malignant origin.