Exploring the rarity: insights into primary diffuse large B-cell lymphoma of the prostate from a global retrospective analysis

Abstract

Background: The purpose of this study is to comprehensively analyze cases of primary diffuse large B-cell lymphoma of the prostate (P-DLBCL-P) from a global perspective, aiming to understand the disease's characteristics, treatment responses, and outcomes. By doing so, we seek to establish a valuable reference for the clinical management of this rare malignancy.

Materials and methods: This study conducted a retrospective review of P-DLBCL-P cases reported worldwide, using various online databases, including PubMed, Scopus, and other English databases, as well as WanFang Data and China National Knowledge Infrastructure in Chinese, collecting clinical pathology information, treatment modalities, and prognosis of patients, and conducted survival analysis using the Kaplan-Meier method.

Results: A cohort comprising 68 patients was enrolled in this study. Lower urinary tract symptoms were prevalent in 90.63% of cases. Furthermore, 89.5% of patients exhibited prostate-specific antigen levels below the threshold of 4 ng/mL. Prostate biopsy was the most commonly used method, accounting for 52.38% of cases, followed by transurethral resection of the prostate at 33.33%. Approximately 33.90% of patients diagnosed with prostate lymphoma experienced stage IV disease, with the bladder or ureter being the organs most frequently involved (53.33%). Surgical procedures were associated with an elevated risk of uncontrollable hemorrhage. Notably, chemotherapy demonstrated a positive therapeutic response, resulting in a complete remission rate of 50.94% and a partial remission rate of 28.30%. A subsequent follow-up study revealed a 1-year survival rate of 73.08% and a 3-year survival rate of 65.38%.

Conclusions: The symptoms of P-DLBCL-P are often atypical, leading to many patients being diagnosed at a later stage of the disease. Through a global study of cases, we have confirmed the efficacy of the rituximab-cyclophosphamide-adriamycin-vincristine-prednisone regimen as the preferred treatment option. Surgical intervention is typically only used for diagnostic purposes or to relieve organ obstruction.

Keywords: Chemotherapy; Diffuse large B-cell lymphoma; Pathology; Prostate lymphoma; Surgical treatment.

Fig. 1

MRI features and pathological diagnosis of prostate DLBCL. MRI features of DLBCL in the prostate gland (A–C) display a diffusely enlarged prostate with (A) hypointensity on T2-weighted imaging (T2WI), (B) hyperintensity on diffusion-weighted imaging (DWI), and (C) decreased apparent diffusion coefficient (ADC) values. The pathological features of DLBCL derived from GC in prostate (D–G) include the following: (D) HE staining shows the tissue morphology, (E) CD20 is diffusely positive, (F) MUM-1 is negative, (G) Bcl-6 is positive, (H) CD10 is positive, and (I) Ki67 is highly expressed. The magnification used for the image is 400. Abbreviations: ADC, apparent diffusion coefficient; DLBCL, diffuse large B-cell lymphoma; GC, germinal center; HE, hematoxylin and eosin.

Fig. 2

Prognosis analysis of different treatment approaches and disease stages in patients with P-DLBCL-P. (A) Survival analysis comparing the efficacy of chemotherapy alone versus surgery + chemotherapy. (B) Survival analysis comparing the outcomes of R-CHOP and CHOP treatments. (C) Subgroup analysis based on the pathology of GC, NGC, and IVLBCL subtypes. (D) Prognosis analysis across various disease stages in P-DLBCL-P patients. GC, germinal center; IVLBCL, intravascular large B-cell lymphoma; NGC, nongerminal center; P-DLBCL-P, primary diffuse large B-cell lymphoma of the prostate; R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.