|Year : 2016 | Volume
| Issue : 4 | Page : 569-571
Occurrence of carcinoma prostate in the Pune Metropolitan Region: A 5-year study from 2007 to 2011
SS Bapat, BD Kashyapi
Department of Urology, Ratna Memorial Hospital, Maharashtra Medical Research Society, Pune, Maharashtra, India
|Date of Web Publication||21-Apr-2017|
Department of Urology, Ratna Memorial Hospital, Maharashtra Medical Research Society, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
BACKGROUND: A retrospective study was carried out to know only the occurrence of carcinoma prostate (CAP) in the Pune Metropolitan Region (PMR) over a period of five years (January 01, 2007 to December 31, 2011). All the histopathological (HPE) reports of all prostate specimens were collected from 23 medical colleges, private institutions and stand-.alone HPE laboratories in PMR. MATERIALS AND METHODS: Four types of prostate specimens were examined – endoscopic resection, open prostatectomy, transrectal needle biopsy of prostate and prostate from the cystoprostatectomy specimen (surgery carried out for primary carcinoma bladder). Specimens of radical prostatectomy were excluded as the biopsy was carried out earlier. RESULTS: A total of 5006 reports of the prostate specimens were examined out of which 779 showed the presence of CAP. Analysis of annual occurrence of CAP revealed that there was no significant variation in the CAP cases. Thus giving an average of CAP cases of 155.8 per year in PMR. Population data of the PMR was obtained from the official Government of India Census department for the year 2011. Total population of PMR in 2011 was 5,049,968 out of which the male population was 2,659,484. Thus the occurrence of CAP in the PMR works out to 5.86/100,000 male population. Results were compared with the published reports of CAP by the Indian Council of Medical Research (ICMR) of 7.2/100,000 and Globocon of 4.2/100,000 males. CONCLUSIONS: Occurrence of CAP in PMR is low at 5.86/100,000 male population is comparable with published figures of ICMR & Globocon 2012.
Keywords: Carcinoma prostate, occurrence, Pune metropolitan region
|How to cite this article:|
Bapat S, Kashyapi B. Occurrence of carcinoma prostate in the Pune Metropolitan Region: A 5-year study from 2007 to 2011. Indian J Cancer 2016;53:569-71
| » Introduction|| |
Cancer of prostate (CAP) is one of the common cancers afflicting the male population and its incidence increases with the age. In a country like India with a population of over 1.2 billion, near accurate incidence of CAP is unavailable.
In the normal clinical scenario, patient presents with symptoms of lower urinary tract symptom (LUTS). If the clinical examination reveals a suspicious nodule, or on routine prostate-specific antigen (PSA) examination (during the annual checkup), the PSA level is found to be raised, these patients are subjected to a standard set of investigations including transrectal ultrasound (TRUS)-guided prostate biopsy to confirm the presence of CAP. The patient is declared to be suffering from cancer prostate only after histopathological examination (HPE) confirms the malignancy. Hence, the authors decided to conduct a retrospective study to ascertain only the number of CAP cases and calculate the occurrence of CAP in the Pune Metropolitan Region (PMR).
Authors contacted all the centers where HPE is carried out in PMR and collected data for the period of 5 years (January 01, 2007 to December 31, 2011). A total of 5006 HPE reports of prostate tissue were collected and analyzed. Analysis of clinical stage at presentation, treatment received, and survival statistics were not carried out. These reports were tabulated yearly and analyzed.
| » Methods|| |
This study was undertaken after due permission from the Institutional Ethics Committee.
The PMR is an area marked out by the Census Department, Government of India. PMR includes the city of Pune, adjoining cities of Pimpri and Chinchwad and surrounding villages. Through the local association of histopathologists in PMR area, we contacted all the medical colleges, private institutions, and stand-alone HPE laboratories in PMR. We requested them to supply us data about all the prostate specimens they received for HPE in a specified format on yearly basis over a period of 5 years from January 01, 2007 to December 31, 2011. In all 26 institutions, stand-alone laboratories were requested to furnish us the data. Out of these, three institutes declined to provide the details.
Information that we requested was:
- Date of reporting
- Age of the patient and the PSA value (wherever available)
- Nature of the specimen – one of the four types (vide infra)
- HPE diagnosis with Gleason score (when it was CAP).
Clinical details of each patient could not be collected from the HPE laboratories, as they had no access to the patients or their case papers.
Prostate specimens were divided into four groups as shown in [Table 1].
Since the main objective of the study was to know the occurrence of CAP in PMR over 5 years, a combined 5-year data is presented rather than yearly data. In addition, analysis of yearly occurrence of CAP revealed that there was no significant variation in the CAP on yearly occurrence, authors decided to consider an average of 5 years [Table 2].
|Table 2: Combined 5 years analysis of the histopathology reports - 2007-2011|
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| » Results|| |
Analysis of occurrence of CAP revealed that:
- Transurethral resection of the prostate (TURP) group showed 7.84% of CAP
- Open prostatectomy group showed 9.48% CAP
- Needle biopsy group showed 52.98% CAP
- Cystoprostatectomy (CPS) group showed 16.17% independent CAP associated with primary carcinoma of urinary bladder
- The gross percentage of CAP from all the collected HPE reports is 15.56%.
We further looked in the number of CAP cases year wise [Figure 1].
| » Discussion|| |
CAP is one of the common cancers afflicting the male population. Its incidence increases with the age. With the increase in the longevity of the population, in general, its incidence is bound to increase.
The Indian Council of Medical Research (ICMR) established the National Cancer Registry Program (NCRP). The first Population-based Cancer Registry (PBCR) to cover the urban population was established in five cities - Mumbai, New Delhi, Chennai, Bengaluru, and Bhopal. From 1982 to 2003, the study showed increase in the incidence rate of CAP from 1.7–3.9 in Chennai to 6–7.2 in Mumbai/100,000 male population.
NCRP – ICMR, Bengaluru, India, published a 3-year report of the PBCR's 2009–2011. Incidence of CAP was variable in different regions in India. Lowest incidence was in Tripura at 0.5/100,000 to the highest in Kamrup Urban District at 11.2/100,000 and New Delhi was the second highest at 10.7/100,000 male population. The incidence of CAP in PMR was recorded at 7.2/100,000 male population.
As per the Globocan, in Asia, the incidence of CAP was lowest in Bhutan (1.1/100,000) and highest in Singapore (33/100,000) with India at 4.2/100,000.
In the normal clinical scenario, patient presents with symptoms of LUTS. If the clinical examination reveals a suspicious nodule, or on routine PSA examination (during annual health checkup), the level is found to be raised, these patients are subjected to a standard set of investigations to confirm the presence of CAP. Finally, TRUS-guided prostate biopsy is carried out. The patient is declared to be suffering from CAP only after HPE confirms the malignancy.
Hence, the authors decided to conduct a retrospective study to ascertain only the number of CAP cases and calculate the occurrence of CAP in the PMR.
In the PMR, there are many medical colleges, private institutions, and many smaller hospitals that carry out surgery on the prostate. All medical colleges and private institutions have a full-fledged HPE Department. Smaller hospitals send their specimens for HPE to the bigger institutes or stand-alone special HPE laboratories. We contacted all the HPE specialists through their association and they agreed to help us in our project.
Authors decided to collect all the HPE reports of the prostate tissue from PMR for a period of 5 years from January 01, 2007 to December 31, 2011 [Table 2]. In all 26 institutions, stand-alone HPE laboratories were requested to furnish us the data. Out of these, three institutes declined to provide the details.
The analysis of the results of the present study shows some important facts:
- Occurrence of CAP in the TURP group was 7.84%
- The occurrence of CAP in the OP group was 9.48%. This was indeed very difficult to explain. However, the overall total percentage of open cases was very small: 2.73%. The HPE reports do not mention about the percentage of tumor in the specimens. Whether these were “incidentally” detected cancers or otherwise is not clear
- Results of the needle biopsy group showed the occurrence of CAP in 52.98%. This compares well with the results from published data 
- In the CPS group, the occurrence of CAP was 16.17%. The published reports also show variable incidental CAP in these specimens up to 70%
- Of the gross total, CAP was found to be present in 15.56% cases.
In the next step, the authors have tried to correlate the number of HPE-proven CAP patients with the population of the PMR. Albeit, there could be some more males above the age of fifty with CAP in PMR, which were not included in the present study. However, unless the presence of CAP was documented with HPE, they were not eligible for inclusion in the present study.
The population census was carried out in 2011. The population of the Pune metropolitan region in 2011 was 5,049,967. Males were 2,659,484. We could collect a total of 5006 prostate HPE reports in 5 years, of which 779 (15.56%) were CAP.
[Figure 1] shows the yearly occurrence of CAP in PMR. Analysis of the yearly occurrence of CAP in the 5 years of the study period - 2007–2011 - revealed an important observation. In the year 2007, the number of recorded CAP cases were the lowest – 123. However, from the year 2008 to 2011, there were no appreciable yearly variations in the detection of CAP. The range varied from 155 to 170 CAP cases/year. Lower detection in the year 2007 could be due to the incomplete detection of reports from the records.
If we apply the principal of finding out the occurrence of CAP/lakh (100,000) of male population, it will be 5.86/100,000 (the total male population in 2011 in PMR was 2,659,484 and average incidence of CAP was 155.8 cases/year). This figure of 5.86/100,000 incidence of CAP in PMR is very close to the incidence of CAP in PMR by the ICMR of 7.2/100,000.
Authors have made a humble attempt to extrapolate the yearly results of HPE to arrive at a possible figure of occurrence of CAP in the present PMR-based population on year basis. Authors acknowledge that there are certain lacunae in the present study:
- Incomplete collection of data (three institutions not participating in the study)
- Possible inability to recover all the HPE reports in the earlier years
- Lack of review of pathological reports by dedicated uropathologist.
Nevertheless, the present study does show a general trend in the incidence of CAP in the PMR at 5.86/100,000 males.
Authors would categorically like to state that, at no time, we are trying to play down the importance of CAP, its early detection and its management.
Our effort is just to find out what is the near correct occurrence of the CAP in the given metropolitan population base.
It is very important for the clinicians to know the incidence of CAP. India is the second most populous country in the world (>1.2 billion). Due to lack of organized and uniform data collection system, it is almost impossible to find out the correct incidence of CAP in the population. There is great regional diversity in health-care facilities that adds to the difficulty in ascertaining near accurate incidence of CAP. This difficulty is further compounded by the large-scale migration of persons from one region to another. Knowing true regional incidence of CAP will help in better allocation of health resources. In this study, authors made an attempt to get near accurate data based on HPE reports. A retrospective HPE study of all malignancies will give some near about idea about the incidence of any malignancy.
Authors would like to propose the following for improved and near accurate data collection:
- Ministry of Health, Government of India to declare any “CANCER” in the human body as a “NOTIFIABLE” disease
- Involve city/state/regional/national level urology associations to collect data under guidance and supervision of ICMR
- These databases can be linked electronically for integration (and avoiding duplication) of data
- Eventually, this database would be an ideal tool for all the clinicians, researchers, epidemiologists, and health-care planners.
| » Conclusions|| |
- Occurrence of CAP in PMR is low – 5.86/100,000 male population is comparable with published figures of ICMR and Globocan 2012
- Authors suggest that the Ministry of Health, Government of India to declare any “CANCER” in the human body as a “NOTIFIABLE” disease and involve city/state/regional/national level urology associations to collect data under guidance and supervision of ICMR.
- Maharashtra Medical Research Society, Pune, for permitting us to carry out the study and sanctioning the funds to collect the entire data
- All the 23 (26 − 3 = 23) institutions and the stand-alone histopathological laboratories who allowed us the access to their records for collecting the data.
Financial support and sponsorship
This study was supported by the Maharashtra Medical Research Society, Pune, for permitting us to carry out the study and sanctioning the funds to collect the entire data.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]