|Year : 2016 | Volume
| Issue : 3 | Page : 429-431
Incidence of prostate cancer at a single tertiary care center in North Karnataka
SC Ghagane1, RB Nerli2, MB Hiremath1, AT Wagh2, PV Magdum2
1 Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
2 Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital, Belagavi, Karnataka, India
|Date of Web Publication||24-Feb-2017|
Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka
Source of Support: None, Conflict of Interest: None
CONTEXT: Prostate cancer (PC) remains one of the most common cancers affecting men today. Thus, understanding the prevalence, disease characteristics, and changing demographics of Indian PC patients has emerged as an important aspect of study. AIMS: We aimed to present the case series of PC patients from single tertiary care center in North Karnataka. SETTINGS AND DESIGN: The study designed over a period of 8 years from 2007 to 2015 was conducted in the Department of Urology, KLES Dr. Prabhakar Kore Hospital, Belagavi, Karnataka. MATERIALS AND METHODS: A total of 471 newly diagnosed patients with PC from 2007 to 2015 were included in the study. Sociodemographic, clinical characteristics, radiological and histopathological findings of all patients were collected and analyzed for the risk of PC. STATISTICAL ANALYSIS USED: The statistical analysis used in this study was IBM SPSS Statistics software Inc., version 20.0. RESULTS: A total of 471 patients were diagnosed with PC, the mean age at presentation was 70 years, and mean prostate-specific antigen (PSA) level was 37.71 ng/mL. Digital rectal examination (DRE) was abnormal in 87.5% of 471 cases. Significant correlation was observed between PSA level and DRE (P = 0.0005), correlation of PSA and Gleason's score was P = 0.0006, and histopathological results showed high risk in patients (P = 0.0001). CONCLUSIONS: This is the first hospital-based study of PC incidence with clinical and histopathological features. PC remains an important public health problem with increasing incidence and significant burden on health-care resources in India.
Keywords: Epidemiology, histopathology, prostate cancer, North Karnataka
|How to cite this article:|
Ghagane S, Nerli R, Hiremath M, Wagh A, Magdum P. Incidence of prostate cancer at a single tertiary care center in North Karnataka. Indian J Cancer 2016;53:429-31
|How to cite this URL:|
Ghagane S, Nerli R, Hiremath M, Wagh A, Magdum P. Incidence of prostate cancer at a single tertiary care center in North Karnataka. Indian J Cancer [serial online] 2016 [cited 2017 Sep 20];53:429-31. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/429/200671
| » Introduction|| |
Prostate cancer (PC) has turned out to be the most important health problem in developed countries during the last two decades. PC is mainly a disease of the aged with more than 70% of the cases occurring in men above 65 years of age. While the increasing age, race, and family history are the only well-known risk factors, the incidence patterns in various countries and ethnic groups specify that the pathogenesis involves strong relationship between environmental and hereditary factors. Epidemiology has played a significant role in learning about the causes of cancer in the past few decades. The aim of this study was to analyze the incidence, clinical, and histopathological features of PC patients from a single tertiary care center.
| » Subjects and Methods|| |
This study involves case series of 471 PC patients diagnosed during the period 2007–2015 in the Department of Urology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka. Medical records of those cases with confirmed clinical, radiological, and histologically diagnosed based on the Gleason's scoring system were included in this study. The data acquisition and interpretation of cases were done by the urologist and subject experts. The variables analyzed were sociodemographic features: patient's age, marital status, occupation, educational status, smoking status, and alcohol consumption and basic clinical features: symptomatology, comorbidities, medical history, earlier history of vasectomy, and family history of PC. Clinical characteristics: prostate-specific antigen (PSA) levels, digital rectal examination (DRE), histopathological findings, and Gleason score for clinical staging were recorded. Computed tomography (CT) scan of the prostate was done in the majority of cases. bone scan, and magnetic resonance imaging (MRI) were done as per clinical indication for diagnostic and staging purposes. Data were entered and analyzed using IBM SPSS Statistics software Inc., version 20.0 (Armonk, NY: IBM Corp.).
| » Results|| |
Prostate cancer incidence
A total of 471 patients were diagnosed with PC during the period 2007–2015. Year-wise distribution of PC incidence with respect to age category and place of residence is summarized in [Table 1].
|Table 1: Prostate cancer incidence rates recorded in North Karnataka with respect to place of residence, age category, and year|
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The median age of the patients (n = 471) was 70 years at the time of diagnosis while most of the patients were older than 50 years. Among 471 cases, around 37.4% of the PC patients with available data stated that they were farmers and rest were labourers (28.0%), professional business men (19.7%), and retired from job (14.9%). Among the patients with known marital status, 98.1% (n = 462) were married; and 77.28% (n = 364) had ≥3 children. Considering smoking, tobacco, and alcohol drinking habits, 18.7% of the patients (n = 88) were active smokers, 25.7% (n = 121) were tobacco chewers, 14.0% were regular consumers of alcohol, and 2.3% (n = 11) patients had multiple habits.
Basic clinical features
Family history was noticed in 0.84% (n = 4), and history of vasectomy was identified in 0.63% (n = 3). Nearly 84.5% of the patients had bothersome symptoms such as frequency, hesitancy, urgency, hematuria, nocturia, retention, poor urinary stream, sensation of incomplete evacuation, and dribbling. Nearly 78.55% of the patients had different concomitant diseases with 22.7% diabetes mellitus, 13.4% hypertension, 6.4% cardiovascular disease, and 6.9% chronic kidney disease, and few other patients had asthma, chronic obstructive pulmonary disease, and Parkinson's disease. The rest 21.4% (n = 101) patients had no comorbidities.
The mean PSA level was 37.70 ng/mL in the entire group (n = 471). The distribution of patients according to PSA levels of 0.1–2.5, 2.5–4.0, 4.0–10.0, 10.0–20, and >20 ng/mL were 4.5%, 3.0%, 18.3%, 30.4%, and 43.9%, respectively. DRE was suspicious for PC in 87.5% of patients with Grade III, 6.8% with Grade II, and 5.7% with Grade I, respectively. There was a significant positive correlation between PSA (ng/mL) levels and DRE at the time of diagnosis (P = 0.0005). Transrectal ultrasound-guided biopsy was the main diagnostic method in 81.52%. The remaining methods were transurethral resection of the prostate (14.22%), digital-guided tru-cut biopsy (4.24%), and CT/MRI scans for staging.
Of all patients, 3.0% had Gleason score of 6 or less; 8.3% had Gleason's score 7, and 88.7% had ≥8 Gleason's score. Six was the most frequent Gleason's score with 2.8%, among the patients with Gleason's score of 7, 58.1% were score of 3 + 4, 40.8% were score of 4 + 3, while only 1.1% was score of 2 + 5. Significant correlation between Gleason's scores and PSA levels (ng/mL) (P = 0.0006) was noticed [Figure 1].
|Figure 1: The correlation of Gleason's scores and prostate-specific antigen levels (ng/mL). P = 0.0006*. *P < 0.05-level of significant|
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Clinical staging of prostate cancer
Based on histopathological and CT/MRI findings, 2.3% patients were of Stage-I, 3.6% were Stage-II, 5.5% were Stage-III, and 88.5% were of Stage-IV. Out of 471 cases, 67.09% had positive metastasis and 32.91% patients had negative metastasis upon having increased PSA levels during the time of diagnosis; there was a statistically significant positive correlation between PSA levels and metastasis diagnosis using CT/MRI scans (P = 0.0001) [Figure 2].
|Figure 2: The correlation of prostate-specific antigen levels (ng/mL) with positive and negative metastasis during diagnosis using computed tomography/magnetic resonance imaging scans. P = 0.0001*. *P < 0.01-level of significant|
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| » Discussion|| |
It is known that PC is a disease occurring mainly among the elderly population in India as in other parts of the world. At the time of diagnosis, the highest incidence rate was observed among patients aged between 70 and 80 years [Table 1]. This is compatible with the well-known characteristics of the disease that frequently affects elderly men aged 65 years or more and is a rare disease before 50 years of age. Median age was 70 years, and of all 70.7% were above 60 years, which is compatible with the studies from American population. Similarly, we observed specific job-related exposure might account for some cases occupational such as cadmium and rubber making industries generally have yielded consistent association with PC risk. A higher incidence of PC has been reported in men with occupation of farming in our study; this might be due to the exposure agents such as organophosphate and pesticides used primarily in farming. Our findings related to patient profile revealed 37.4% of the PC patients with available data stated that they were farmers and rest were labourers (28.0%), professional business (19.7%), and retired from job (14.9%). About 84.5% of the patients had lower urinary tract symptoms. Nearly 78.55% of the patients had different concomitant diseases with 22.7% diabetes mellitus, 13.4% hypertension, 6.4% cardiovascular disease, and 6.9% chronic kidney disease; few other patients had asthma, chronic obstructive pulmonary disease, and Parkinson's disease. The rest 21.4% (n = 101) patients had no comorbidities. Our findings with low level (22.7%) comorbidity with diabetes mellitus are less significant with the previous meta-analysis findings providing strong evidence that diabetes mellitus is linked with an increased risk of PC in Asians.
Identification of positive family history for PC in first-degree relatives only in 0.84% of our patients is in line with the past studies indicating known susceptibility genes to be involved in only approximately 10% of cases. In India, vasectomy is a common method of family planning. Thus, marginal decreases in the odds were found for vasectomy in our study; the association was not statistically significant. The mean PSA level was 37.70 ng/mL in the entire group. However, most patients had a PSA level ≥20 ng/mL in our study. Histopathological and CT/MRI reports revealed that most of the patients (64.4%) were diagnosed with Stage-III and Stage-IV. We found significant positive correlation between serum PSA level and Gleason score in accordance with the findings of the studies done in European continent and Middle East countries. Most of the patients had Gleason score of ≥8 (88.7%) in our study while 8.3% had Gleason's score 7 and 3.0% had Gleason score of 6 or less while it was reported as seven in Asian subcontinents. The spectrum of cancer epidemiology seen in India is different than that seen in any developed country. Thus, the analyzed data suggest that there is a lesser incidence of PC in some areas of North Karnataka or as is more likely; there is under-ascertainment of cases. However, we feel that this case series of PC data also gives a different standpoint for accumulated knowledge of the information on PC which may have significant epidemiological and statistical value for future studies.
| » Conclusions|| |
We may conclude that PC remains an important public health concern in India with continual increase in the incidence and significant burden on health-care resources. Further studies are needed to better understanding of the etiology and prevention aspects of the PC. The facts behind these results emphasize the need for elaborate and precise molecular and genetic studies of the population.
The authors wish to thank the authorities of Department of Urology, KLE Kidney Foundation and Department of Medical Records and Biostatistics, KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi, for providing the facilities and access to the clinical data. The authors appreciate the support of eminent urology consultants Dr. S. I. Neeli, Dr. Vikram Prabha, Dr. Shishir Devaraju, Dr. Shivagouda Patil, Dr. Amey Pathade, Dr. Nitin Pingale, Dr. Vikas Sharma, Dr. Ranjeet Patil, Dr. Abhijeet Musale, Dr. Shankar K, Mr. Neeraj Dixit, Mr. Ravi Shankeshwar, and Dr. S B. Javali, in the presentation and analysis of data.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Jain S, Saxena S, Kumar A. Epidemiology of prostate cancer in India. Meta Gene 2014;2:596-605.
Hariharan K, Padmanabha V. Demography and disease characteristics of prostate cancer in India. Indian J Urol 2016;32:103-8.
Marså K, Johnsen NF, Bidstrup PE, Johannesen-Henry CT, Friis S. Social inequality and incidence of and survival from male genital cancer in a population-based study in Denmark, 1994-2003. Eur J Cancer 2008;44:2018-29.
Zorlu F, Zorlu R, Divrik RT, Eser S, Yorukoglu K. Prostate cancer incidence in Turkey: An epidemiological study. Asian Pac J Cancer Prev 2014;15:9125-30.
Cózar JM, Miñana B, Gómez-Veiga F, Rodríguez-Antolín A, Villavicencio H; Urology Units, Asociación Española de Urología, et al.
Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010. BJU Int 2012;110(11 Pt B):E701-6.
Doolan G, Benke G, Giles G. An update on occupation and prostate cancer. Asian Pac J Cancer Prev 2014;15:501-16.
Long XJ, Lin S, Sun YN, Zheng ZF. Diabetes mellitus and prostate cancer risk in Asian countries: A meta-analysis. Asian Pac J Cancer Prev 2012;13:4097-100.
Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostate cancer: Prediction, detection and monitoring. Nat Rev Cancer 2008;8:268-78.
Albasri A, El-Siddig A, Hussainy A, Mahrous M, Alhosaini AA, Alhujaily A. Histopathologic characterization of prostate diseases in Madinah, Saudi Arabia. Asian Pac J Cancer Prev 2014;15:4175-9.
Arshad H, Ahmad Z. Overview of benign and malignant prostatic disease in Pakistani patients: A clinical and histopathological perspective. Asian Pac J Cancer Prev 2013;14:3005-10.
[Figure 1], [Figure 2]