title: The clinical features of anterior prostate cancers.
abstract: OBJECTIVE
  To identify the clinical characteristics of anterior prostate cancers (APCs) and to compare these with posterior prostate cancers (PPCs).
  
  
  METHODS
  We reviewed 1290 consecutive open and laparoscopic radical prostatectomies (RPs) at the authors' institution from January 2000 to March 2004. Prostates were processed using a whole-mount technique. Each surgical specimen was reviewed by one pathologist, and tumour areas were marked, measured and mapped. Positive surgical margins (PSMs) were defined as the presence of cancer cells at the inked surface of the specimen. Specimens were then categorized by the location of their dominant tumour, i.e. pure anterior, anterior > posterior, posterior > anterior, or pure posterior. We compared the clinical and pathological characteristics of 259 patients in the pure-anterior group with the 594 in the pure-posterior group.
  
  
  RESULTS
  Before RP, APCs had a significantly lower biopsy Gleason score (78% vs 68% with Gleason 4-6), fewer mean biopsy cores positive (2.0 vs 2.6), a smaller median percentage of positive cores (17% vs 26%), lower clinical stage (T1 in 79% vs 62%), and higher progression-free probability estimated by preoperative nomogram (86% vs 84%) than PPCs. Patients with APCs also had more previous negative biopsy sessions. The pathological analysis of RP specimens showed that those with APCs had higher tumour volume (1.6 vs 0.83 mL) and had a higher PSM rate (12% vs 7%) than those with PPCs, despite specimens with PPCs having higher rates of extraprostatic extension (10% vs 19%).
  
  
  CONCLUSIONS
  APCs have lower Gleason grade and lower rates of extraprostatic extension, yet patients with anterior tumours have higher overall tumour volumes and higher PSM rates. Because current tools for detecting and staging prostate cancer can underestimate the extent of anterior prostate disease, improved methods are needed for localizing and characterizing anterior cancers.
authors.affiliation: Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA. koppiet@mskcc.org
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Bianco
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuroiwa
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillonneau
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
mesh_terms: D015331:Cohort Studies; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery