Histological patterns of prostate specimens analyzed at Jaramogi Oginga Odinga teaching and referral Hospital

Abstract

Prostate cancer is the fifth most prevalent cause of cancer-related death worldwide in men, accounting for an estimated 366,000 deaths and 6.3 million disability-adjusted life years. There is scarce information on prostate biology and histological characteristics of prostate tumors among men in western part of Kenya who are all exposed to factors that can alter the biology of prostate gland thus predisposing to prostate cancer variants that may be different from the conventional adenocarcinoma. Such scarcity of information could lead to assumptions that all prostate tumors are adenocarcinoma. While some prostate tumors are not aggressive, there are different types of prostate tumors and each prostate tumor type has unique clinical profile. Some prostate tumors have indolent course while others have aggressive course and therefore knowledge of tumor subtypes can help in clinical decision making based on patient profile. This purpose of the study was to investigate prostate histological patterns among patients whose prostate specimens were processed and reported at JOOTRH between 2017 and 2022 with a focus on improving prostate cancer diagnosis and histology reporting. The main objective was to determine histological patterns of prostate specimens at JOOTRH between 2017 and 2022. The specific objectives were to: find out the histomorphology of prostate specimens as reported at JOOTRH, to correlate the patient age and PSA level at the time of prostate specimen collection at JOOTRH and to determine the common prostate tumor type reported in men whose prostate specimens were analyzed at JOOTRH. This was a laboratory based cross sectional study design carried out in pathology laboratory at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu city. The target population in this study constituted prostate specimens which had PSA level, analyzed and reported at JOOTRH between 2017 and 2022. The study was carried out between December 2022 and February 2023. Using Yamane formula, the sample size was determined to be 80. Random sampling was used. A sampling frame consisted of pathology register of the histopathological reports of the prostate specimens analyzed at JOOTRH. Each name in the register was assigned serial numbers. All the numbers were fed in a computer program (randomizer application) to randomly sample 80 names. Data extraction form was used. The extraction form consisted of age of the patient, clinical notes (PSA and Age), macroscopic examination, microscopic examination of the prostate tissues and conclusion. Descriptive and inferential statistics was done by the SPSS version 29 for windows. The frequencies were tabulated in percentages, tables and graphs. Inferential statistics utilized chi-square, ANOVA, independent t test, one sample chi-square and linear regression. P value less than 0.05 was considered statistically significant. There was statistically significant variation (p 0.001) in prostate specimen color as reported in prostate histology at JOOTRH. The researcher could not demonstrate that the prostate specimen surfaces occur with equal changes (p<0.05, X2=23.275, df=2, 95% CI). The results reveal that there is no statistically significant difference in the prostate biopsy sizes in comparison to the mean (p=0.984, t=0.020, 95% CI). Prostate histology reports were divided into four groups based on the age of the patient (Group 1: 40–49 years, Group 2: 50–59 years, Group 3: 60–79 years, and Group 4: above 80 years). The ANOVA results suggest that the microscopic features of the groups did not differ significantly (F2, 34 = 1.469, p = 0.244, 95% CI). There is a statistically significant positive correlation between Gleason scores and PSA levels (p = 0.004, r = 0.474). The Pearson correlation between age and PSA levels was found to have a statistically significant positive correlation (r = 0.236, p = 0.035, 95% CI). Regarding the prostate tumor type, prostate adenocarcinoma was the predominant tumor type, accounting for all 100% of observed prostate cancer types. The tumor types reported were divided into four groups based on the age of the patient (Group 1: 40–49 years, Group 2: 50–59 years, Group 3: 60–79 years, and Group 4: above 80 years). The ANOVA results suggest that the types of prostate tumors in the groups did not differ significantly (F3,76 = 1.300, p = 0.28, 95% CI). Based on study results, the health workers should improve documentation of the prostate histology reporting to include core biopsies and gross morphological parameters like volume, description of cell details observed and Biopsies should be requested in cases where there is high likelihood of prostate cancer.