Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 6446


Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 

  Table of Contents  
Year : 2015  |  Volume : 56  |  Issue : 5  |  Page : 338-343  

A histopathological study of prostate lesions in Lagos, Nigeria: A private practice experience

1 Department of Pathology, University of Uyo, Uyo, Akwa Ibom State, Nigeria
2 Department of Pathology, Me Cure Healthcare Limited, Oshodi, Lagos State, Nigeria

Date of Web Publication24-Nov-2015

Correspondence Address:
Chukwuemeka Charles Nwafor
Department of Pathology, University of Uyo, Uyo, Akwa Ibom State
Login to access the Email id

Source of Support: None, Conflict of Interest: None

PMID: 26778885

Rights and PermissionsRights and Permissions

Introduction: Prostatic carcinoma (CaP) is globally the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. The aim of this study is to determine the pattern of histopathological types of prostatic lesions seen in a private laboratory in Lagos, Nigeria. Materials and Methods: Histopathological reports of all prostate specimens, which were received and processed by histopathology section of a private laboratory in Lagos, Nigeria, from August 2009 to December 2013 were reviewed. Results: A total of 304 prostatic tissue specimens were received and processed during the period under review. The youngest patient was 32 years old while the oldest patient was 99 years old with a mean of 67.8 years ± 9.5. The most common diagnosis was benign prostatic hyperplasia (BPH) (62.8%), distantly followed by CaP (29.3%), inadequate samples (6.6%), prostatic intraepithelial neoplasia (1%), and metastasis to the prostate (0.3%). The peak incidence was age group of 60-69 years, closely followed by 70-79 years accounting for 38.2% and 36.2%, respectively. Moderately differentiated CaP (Gleason scores [GSs] 5-7) accounted for 58.1% of the cases while GS 7 was the most common individual score and was seen in 32.3% of the CaP cases. Conclusion: In this private practice, BPH is the most common prostate lesion. CaP is relatively high and most of the cases have a high GS that portends high mortality in our population. Efforts should be made to increase awareness so as to reduce the mortality.

Keywords: Benign prostatic hyperplasia, private practice, prostatic carcinoma

How to cite this article:
Nwafor CC, Keshinro OS, Abudu EK. A histopathological study of prostate lesions in Lagos, Nigeria: A private practice experience. Niger Med J 2015;56:338-43

How to cite this URL:
Nwafor CC, Keshinro OS, Abudu EK. A histopathological study of prostate lesions in Lagos, Nigeria: A private practice experience. Niger Med J [serial online] 2015 [cited 2024 Feb 22];56:338-43. Available from: https://www.nigeriamedj.com/text.asp?2015/56/5/338/170388

   Introduction Top

Diseases of the prostate constitute a significant portion of the cases seen by urologists in males and are substantial sources of morbidity and mortality among adult male population worldwide.[1],[2] Three pathologic processes mainly affect the prostate gland: Inflammatory (prostatitis), benign prostatic hyperplasia (BPH), and tumors (premalignant and malignant lesions). Of these three, BPH is the most common and occurs so often in an advanced age that they can almost be construed as a "normal" aging process. Prostatic carcinoma (CaP) is also an extremely common lesion in men.[3] Prostatitis may be acute or chronic bacterial prostatitis, chronic abacterial prostatitis, or granulomatous prostatitis.[3] Histologic evidence of BPH can be seen in approximately 20% of men by 40 years of age, a figure that increases to 70% by age 60 and to 90% by age 80.[3] The pathophysiology of BPH remains incompletely understood. The development of the histologic features of BPH is dependent on the bioavailability of testosterone and its metabolite, dihydrotestosterone.[4] Additional risk factors include several modifiable factors involved in metabolic syndromes such as obesity, diabetes, high levels of alcohol consumption, and physical inactivity.[5] Furthermore, race, black (vs. white) is suspected to play a role. The mechanisms underlying these associations remain poorly understood.[5] Globally, BPH affects about 210 million males.[6] Various studies reported the rate of BPH to be in the range of 67.5-87.5% of prostatic lesions and gave a peak age of 6th and 7th decades for those affected.[2],[7],[8],[9],[10],[11],[12],[13],[14 Studies from Saudi Arabia and India reported the 7th decade while study in Pakistan and all Nigerian studies except that from Benin reported the 6th decade as the peak age group affected.[2],[7],[8],[9], [13,[14]

CaP is globally the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males.[15] The worldwide incidence of CaP has been rising rapidly, likely due to intensified effort in early detection and screening.[16] It is of such a great magnitude that in the United States, it is postulated that 1 in 6 American men will develop CaP over his lifespan.[17] The incidence of CaP is said to be low in China and some parts of Asia but in Nigeria, CaP has assumed the number one position in male cancers, constituting 11% of all male cancers.[16],[18] The major risk factors for CaP are race, age, and family history of prostate cancer.[16] Other suggested but inconclusively agreed risk factors include association with bladder cancer, cigarette smoking, vasectomy, and sexual behavior.[16] CaP rates in various studies were in the range of 12.5-30.9% of prostatic lesions.[2],[7],[8],[9],[10],[11],[12],[13],[14] All Nigerian studies except the study from Ilorin reported a rate of at least 22.4%.[2],[10],[11],[12],[13]

All the foreign studies and all the Nigerian studies, but one was hospital-based studies conducted in tertiary health care facilities, which usually serve as referral centers (putting a high selective index on the data from such institutions), however, many Nigerians visit privately owned hospitals for their health needs. These privately operated hospitals usually utilize the services of privately owned laboratories like the setting where this study was done. This research was carried out in a private laboratory in Lagos, Nigeria to study the histopathological types of prostatic lesions seen. We set out to review our data base with respect to prostatic lesions to see the pattern in relation to those from government owned tertiary hospitals and to add to the growing database of prostatic lesions so as to help to combat CaP menace through actions such as health education and screening programs.

   Materials and Methods Top

This retrospective study included histopathological reports of all prostate specimens, which were received and processed by histopathology section of Me Cure Health Limited, Lagos, Nigeria (a modern, large privately owned diagnostic establishment), from August 2009 to December 2013. This histopathology section renders services to many privately owned hospitals within Lagos State and few neighboring states. These prostate specimens were received in 10% buffered formalin and processed with auto processors. Paraffin-embedded sections (at 2-3 µm) were routinely stained with hematoxylin and eosin stains. Data were extracted from the establishment computer database entered into an excel sheet and analyzed using predictive analytical software, version 17 (IBM, SPSS Inc., Chicago, IL, USA), with respect to age, frequency, histological types of lesion, and Gleason grading for prostatic adenocarcinomas. The research was approved by a review board of the establishment.

   Results Top

A total of 304 prostatic tissue specimens were received and processed during the 5 years period under review. This accounted for 6.5% of all 4642 specimens processed in the histopathology laboratory. Prostatectomy accounted for 10% of all specimens, while Tru-Cut needle biopsies accounted for 90% of all specimens, as shown in [Figure 1]. The youngest patient was 32 years while the oldest patient was 99 years with a mean of 67.8 years ± 9.5 standard deviation. The most common diagnosis was BPH (62.8%), distantly followed by CaP (29.3%), inadequate specimens (6.6%), prostatic intraepithelial neoplasia (PIN) (1%), and metastasis to the prostate (0.3%) as shown in [Table 1]. Of the CaP cases, 97.8% were from Tru-Cut needle biopsy specimens, while 2.2% were from prostatectomy cases (incidental carcinoma). The age group 60-69 years, closely followed by age group 70-79 years accounted for most lesions (38.2% and 36.2%, respectively). The age groups 30-39 and ≥90 years accounted for the least number of cases (1% each) as shown in [Table 1]. No case of CaP was seen in age groups 30-39 and ≥90 years age group.
Figure 1: Specimen distribution

Click here to view
Table 1: Histological types of prostatic lesions in relation to age

Click here to view

Gleason score (GS) 7 was the most common score and was seen in 32.3% of CaP cases while 17.7% of CaP cases had GS 9 and 14.5% had GS 6. The least score recorded was GS 3, which was seen in 1.6% of cases as shown in [Table 2]. Moderately, differentiated CaP (GSs 5-7) accounted for 58.1% of cases, while poorly differentiated cases (GSs 8-10) accounted for 33.8% of cases, and well-differentiated cases (GSs 2-4) accounted for the least number of cases (8.1%).
Table 2: Frequency of GS in relation to age groups

Click here to view

A total of 62 cases of BPH were associated with other histological changes. Of these changes, chronic prostatitis, acute prostatitis, and squamous metaplasia accounted for 82.3%, 16.1%, and 1.6%, respectively.

   Discussion Top

In recent times in Nigeria, there have been a lot of industrial actions by the various unions in the health sector, which has resulted in shutting down of the hospitals for several weeks and at times even months. This has made many Nigerians to utilize the services of privately owned hospitals and health facilities like the facility where this study was carried out in. This study was conducted in Lagos, Nigeria. Lagos State has the highest population in Nigeria, which is over 5% of the national estimate and currently has a population of over 21 million.[19] This high population makes the government owned health sector to be overstretched even when they are working. Because of the above two reasons (frequent industrial actions and high population density), many inhabitants of Lagos State utilize the services of privately owned hospitals and facilities. These privately owned hospitals usually send tissue specimens to privately owned laboratories like ours. Since privately owned establishments are playing a role in citizen's health; hence, there is the need to include information from these privately owned health facilities into the national database.

Specimens of prostate accounted for 6.5% of all histopathological specimens. This rate is higher than 3.2% reported in Jos and 3.6% reported in a previous study from Lagos.[12],[14] However, the rate of 6.5% is close to 7.4% reported in Kano.[13] Lagos and Kano are said to be the two most populated states in Nigeria and this may explain the high rates seen in both states, however, this high rate which still may be a tip of an iceberg, implies that awareness must be increased. Studies by Ukoli et al.,[20] reported that none of their screened Nigerian population after adequate counseling accepted to go for prostate biopsy due to the following reasons; they men had no symptoms and felt it was a waste of their hard earned money, irrational morbid fear of impotence following procedures around their anorectum, fear of the diagnosis, and the possible complications. Studies by Akhator and Essiet [21] on even symptomatic prostate cancer patients in Nigeria showed that the majority refused biopsy regardless of adequate counseling. The need to increase awareness cannot be over emphasized because of these studies by Wilkinson et al. has proven that just an hour dedicated seminar on prostate cancer increased awareness and knowledge from 26% to 73.3%.[22]

The ratio of benign prostatic lesions to CaP is 2.1:1 in this study. This is slightly less than the ratio from the other parts of Nigeria; 2.3:1 in Benin, 2.5:1 in a previous Lagos study, 3:1 in another study from Benin, 3:1 in Jos, and 3.5:1 in Kano but much lower than 4.6:1 reported in Saudi Arabia.[2],[7],[10],[12],[13],[14] Studies have shown that CaP incidence in native Asian men is relatively low when compared with other cancer types but is substantially increased in Asians living in Westernized countries.[23] Reasons for the much lower rate of CaP in Asia is not well known though genetic and environmental factors, particularly Western diet, could partially explain these differences, however, lower exposure to prostate-specific antigen (PSA) screening in Asian individuals might be a major contributing factor.[23]

The frequency of BPH and CaP in this study rises steeply through the age groups, peaking at age groups 60-69 and 70-79 years in almost an equal proportion, followed by a sharp descent thereafter, such that no case of CaP was seen in age group 80-90 years and 90 years and above. No other previous study documented this almost equal distribution of BPH and CaP cases between these two age groups and the reason for this cannot be explained. Though all the previous Nigerian studies and study from Pakistan reported the 6th decade as the major age group involved expect studies in Jos, India, and Saudi Arabia, which reported the 7th decade as the most common age group involved.7, 8, 9, 10, 11, 12, 13 No previous Nigerian study observed a high prevalence in the 8th decade and this is an improvement though the reasons for this is not clear. Slight improvement in life expectancy may have played a role. This finding is at variance with findings in Caucasians, where there is a steady progressive rise in the incidence with a peak at the 9th decade of life, in view of their longer life expectancy and higher standards of living.[24],[25]

BPH accounted for 62.8% of all prostatic lesions, and most cases were in the 7th and 8th decade. BPH is characterized pathologically by a cellular proliferation of the epithelial and stromal elements in the prostate gland. These changes begin histologically in the 3rd decade of life and clinically in the 5th decade of life, resulting in increased resistance to urinary flow during micturition.[8] BPH is an important cause of diminished quality of life among aging men, and the prevalence of this condition is likely to grow as the population ages.[26] Clearly, the most important demographic factor in the incidence and severity of BPH is aging.[26]

Chronic prostatitis accounted for the most of the histological changes associated with BPH in the index study. This is similar to findings from other Nigerian and Saudi Arabian studies.[7],[10],[12],[13] In general prostatitis is seen in about 11-98% of prostatic specimens and its diagnosis is dependent on the criteria used by the assessor.[27] Since the major reason for the removal is either BPH or CaP, some pathologist may not emphasis the presence of inflammatory cells except in rare cases such as tuberculosis or schistosomiasis.

High-grade PIN (HGPIN) accounted for 1% of cases. Similar low rates were reported in Jos and India.[8],[12] PIN is the most established precursor of CaP. The presence of prominent nucleoli within an existing duct structure is an easy way to identify the disorder.[28],[29] Clinical studies suggest that PIN predates carcinoma by 10 years or more, with low-grade PIN first appearing in men in their thirties.[29] The finding of PIN indicates the need for repeat biopsy and follow-up, especially in patients with elevated serum PSA concentration.[29] The clinical significance of HGPIN is that it identifies patients at risk for malignancy.[28] HGPIN and CaP are associated with increased incidence and severity with age, and with high rates of occurrence in the peripheral zone of the prostate. Androgen deprivation therapy decreases the prevalence and extent of PIN, and may play a role in chemoprevention.[28]

CaP accounted for 29.3% of prostatic lesions in the index study. This rate though within the range of 12.5-30% reported by previous studies, however, this rate is higher than the rate reported by most previous Nigerian studies.[10],[12],[13],[14] Thus, suggesting that CaP is high in our environment, and efforts at early detection and awareness should be increased. It is common to see breast and cervical cancer campaign in some major cities in Nigeria by nongovernmental organizations, with some occasional free screening and examination, but same cannot be said for CaP. Cap has been known as a disease of elderly men. Diagnosis is rare before age 50, but after this age incidence increases exponentially, and the rate of increase is faster than that seen in other malignancies. The exact role of age in the development of CaP is controversial.[16] Black race is said to be affected more than other races. African and American men develop the disease 50% more frequently than their white counterparts of the same age.[30] When compared with white Americans, they are younger at the time of diagnosis and their tumors are higher in stage and grade.[31] Furthermore, their 5-year survival rate has been reported to be less than that of their white counterparts.[31] The reasons for the higher prostate cancer incidence in black Americans are not known and are probably multifactorial, combining environmental and genetic factors.[16] A study by Osegbe in Nigeria was of the opinion that there must be a common genetic predisposition between American blacks and Africans, particularly Nigerians.[32]

Thirty-two point three percent of the CaP cases had a GS of 7, which was the most frequent score. This is greater than scores from Jos and Benin, similar to scores from Saudi Arabia and Pakistan, but lesser than a score from a previous study in Lagos.[2],[7],[9],[12],[14] The Gleason grading system, based on architectural features of prostate cancer cells, is the most widely used histological grading method for prostatic adenocarcinoma. The GS closely correlates with clinical behavior and provides an important index of prognosis.[33] Furthermore, this score is one of the key determinants in treatment decision making, together with stage, age, and PSA.[33] It is the only grading system that recognizes the histologic heterogeneity of tumor present within a single prostate specimen by assigning grades to the primary and secondary patterns and combining this grade into the score (scored as 2-10).[34] Though reproducible, across different institutions, stage, and grade depend on the subjective assessment of the investigator(s).[35] Studies have shown that patients with a pathological GS of ≤6 have an excellent progress-free survival, which can be up to 90%. However, men with a GS ≥7 adenocarcinoma have a 29-43% risk of death from prostate cancer.[36] Since GS is an index of prognosis, we can appreciate why CaP has a high mortality in Nigeria because our men present mainly with GS 7 and above. Lack of awareness of the disease has been implicated as the cause of the high scores.[37]

Inadequate specimens accounted for 6.6% of all prostatic specimens seen. This number is quite high, though other studies did not make mention of these group of prostatic specimens, or they were excluded from the study. The major implication of this group of specimens is that when the results of the histopathologic investigation are out, (in our setting minimum of 3 days), both the surgeon and patient are usually too disappointed. The common histopathologic findings in these circumstances are a lack of prostatic glandular elements (which are keys for histological diagnosis) or in some situations presence of only colonic mucosa. Most prostatic biopsies in our environment, not ultrasound-guided. Inadequacy of prostatic biopsy specimens are mainly operator dependent and most prominent in apical and far lateral biopsy specimens.[38] To reduce pain and patient time wastage and embarrassment caused to the surgeon, ultrasound-guided biopsy and avoidance of sampling of apical and far lateral sections of the prostate should be encouraged.

   Conclusion Top

BPH is the most common prostate lesion. Only a few cases of prostatitis and PIN were documented. CaP is relatively high in Lagos, and most of the cases have a high GS that portends high mortality in our population. This rate may be higher if mass screening is introduced; hence, the efforts should be made to increase awareness so as to reduce the mortality associated with CaP. Surgeons should strive to do ultrasound-guided biopsies so as to reduce time wastage and not to discourage the few patients who accepted to do a biopsy.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Umezurike BI, Ekanem TB, Eluwa MA, Etta KK, Udo-Affah GA, Aligwekwe AU. The frequency of benign prostate hypertrophy in Calabar. Niger Postgrad Med J 2006;13:236-9.  Back to cited text no. 1
Forae G, Obaseki DE, Aligbe JU, Ekanem VJ. Morphological patterns of prostatic lesions in Benin City, Nigeria: A twenty year retrospective study. Ann Trop Pathol 2011;2:23-7.  Back to cited text no. 2
Kumar V, Abbas AK, Fausto N, editors. Prostate. In: Robbins Pathologic Basis of Disease. 8th ed. Philadelphia: Saunders Company; 1999.  Back to cited text no. 3
Bartsch G, Rittmaster RS, Klocker H. Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia. Eur Urol 2000;37:367-80.  Back to cited text no. 4
Corona G, Vignozzi L, Rastrelli G, Lotti F, Cipriani S, Maggi M. Benign prostatic hyperplasia: A new metabolic disease of the aging male and its correlation with sexual dysfunctions. Int J Endocrinol 2014;2014:329456.  Back to cited text no. 5
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163-96.  Back to cited text no. 6
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.  Back to cited text no. 7
Josephine A. Clinicopathological study of prostatic biopsies. J Clin Diagn Res 2014;8:FC04-6.  Back to cited text no. 8
Aslam HM, Shahid N, Shaikh NA, Shaikh HA, Saleem S, Mughal A. Spectrum of prostatic lesions. Int Arch Med 2013;6:36.  Back to cited text no. 9
Aligbe JU, Forae GD. Prostatic tumours among Nigerian males: A private practice experience in Benin-City, South-South, Nigeria. Niger Postgrad Med J 2013;20:193-6.  Back to cited text no. 10
  Medknow Journal  
Anjorin AS, Adeniji KA, Ogunsulire IA. Histopathological study of prostatic lesions in Ilorin, Nigeria. Cent Afr J Med 1998;44:72-5.  Back to cited text no. 11
Mohammed AZ, Nwanna EJ, Anjorin AS. Histopathological pattern of prostatic diseases in Nigerians. Afr J Urol 2005;11:33-8.  Back to cited text no. 12
Mohammed AZ, Alhassan SU, Edino ST, Ochicha O. Histopathological review of prostatic diseases in Kano, Nigeria. Niger Postgrad Med J 2003;10:1-5.  Back to cited text no. 13
Anunobi CC, Akinde OR, Elesha SO, Daramola AO, Tijani KH, Ojewola RW. Prostate diseases in Lagos, Nigeria: A histologic study with tPSA correlation. Niger Postgrad Med J 2011;18:98-104.  Back to cited text no. 14
  Medknow Journal  
Dabir PD, Ottosen P, Høyer S, Hamilton-Dutoit S. Comparative analysis of three- and two-antibody cocktails to AMACR and basal cell markers for the immunohistochemical diagnosis of prostate carcinoma. Diagn Pathol 2012;7:81.  Back to cited text no. 15
Delongchamps NB, Singh A, Haas GP. The role of prevalence in the diagnosis of prostate cancer. Cancer Control 2006;13:158-68.  Back to cited text no. 16
Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LA, et al.Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst 2005;97:1407-27.  Back to cited text no. 17
Ogunbiyi JO, Shittu OB. Increased incidence of prostate cancer in Nigerians. J Natl Med Assoc 1999;91:159-64.  Back to cited text no. 18
Population. Lagos State Government. Available from: http://www.lagosstate.gov.ng/pagelin . [Last accessed on 2014 Jan 13].  Back to cited text no. 19
Ukoli F, Osime U, Akereyeni F, Okunzuwa O, Kittles R, Adams-Campbell L. Prevalence of elevated serum prostate-specific antigen in rural Nigeria. Int J Urol 2003;10:315-22.  Back to cited text no. 20
Akhator A, Essiet DF. Fear of prostate biopsy: A limitation in the management of prostate cancer. Niger J Clin Pract 2010;13:64-6.  Back to cited text no. 21
  Medknow Journal  
Wilkinson S, List M, Sinner M, Dai L, Chodak G. Educating African-American men about prostate cancer: Impact on awareness and knowledge. Urology 2003;61:308-13.  Back to cited text no. 22
Ito K. Prostate cancer in Asian men. Nat Rev Urol 2014; 11:197-212.  Back to cited text no. 23
Barry MJ. Epidemiology and natural history of benign prostatic hyperplasia. Urol Clin North Am 1990;17:495-507.  Back to cited text no. 24
Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Pathology and Genetics of Tumours of the Urinary Tract and Male Genital Organs. Lyon: IARC Press; 2004. p. 159-214.  Back to cited text no. 25
Glenn SG. The definition of benign prostatic hyperplasia. Epidemiology and prevalence. In: McVary KT, editor. Management of Benign Prostatic Hypertrophy. Totowa, NJ: Humana Press Inc.; 2004. p. 21-35.  Back to cited text no. 26
Kohnen PW, Drach GW. Patterns of inflammation in prostatic hyperplasia: A histologic and bacteriologic study. J Urol 1979;121:755-60.  Back to cited text no. 27
Brawer MK. Prostatic intraepithelial neoplasia: An overview. Rev Urol 2005;7 Suppl 3:S11-8.  Back to cited text no. 28
Bostwick DG. High grade prostatic intraepithelial neoplasia. The most likely precursor of prostate cancer. Cancer 1995;75:1823-36.  Back to cited text no. 29
Brawley OW. Prostate cancer and black men. Semin Urol Oncol 1998;16:184-6.  Back to cited text no. 30
Austin JP, Aziz H, Potters L, Thelmo W, Chen P, Choi K, et al.Diminished survival of young blacks with adenocarcinoma of the prostate. Am J Clin Oncol 1990;13:465-9.  Back to cited text no. 31
Osegbe DN. Prostate cancer in Nigerians: Facts and nonfacts. J Urol 1997;157:1340-3.  Back to cited text no. 32
Graham J, Baker M, Macbeth F, Titshall V; Guideline Development Group. Diagnosis and treatment of prostate cancer: Summary of NICE guidance. BMJ 2008;336:610-2.  Back to cited text no. 33
Deshmukh N, Foster CS. Grading prostate cancer. In: Foster CS, Bostwick DG, editors. Pathology of the Prostate. Philadelphia: W.B. Saunders Company; 1998. p. 207.  Back to cited text no. 34
Lilleby W, Torlakovic G, Torlakovic E, Skovlund E, Fosså SD. Prognostic significance of histologic grading in patients with prostate carcinoma who are assessed by the Gleason and World Health Organization grading systems in needle biopsies obtained prior to radiotherapy. Cancer 2001;92:311-9.  Back to cited text no. 35
Sweat SD, Bergstralh EJ, Slezak J, Blute ML, Zincke H. Competing risk analysis after radical prostatectomy for clinically nonmetastatic prostate adenocarcinoma according to clinical Gleason score and patient age. J Urol 2002;168:525-9.  Back to cited text no. 36
Oluwabunmi EO, Eme O, Modupe L. Knowledge and Awareness of Prostate Cancer in Men Than ≥40 Years in Ibadan South Western Nigeria. UICC World Cancer Congress; July 09, 2006.  Back to cited text no. 37
Dogan HS, Aytac B, Kordan Y, Gasanov F, Yavascaoglu I. What is the adequacy of biopsies for prostate sampling? Urol Oncol 2011;29:280-3.  Back to cited text no. 38


  [Figure 1]

  [Table 1], [Table 2]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal