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Prostate zones and cancer: lost in transition?

Nature Reviews Urology volume 19, pages 101–115 (2022)Cite this article

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Abstract

Localized prostate cancer shows great clinical, genetic and environmental heterogeneity; however, prostate cancer treatment is currently guided solely by clinical staging, serum PSA levels and histology. Increasingly, the roles of differential genomics, multifocality and spatial distribution in tumorigenesis are being considered to further personalize treatment. The human prostate is divided into three zones based on its histological features: the peripheral zone (PZ), the transition zone (TZ) and the central zone (CZ). Each zone has variable prostate cancer incidence, prognosis and outcomes, with TZ prostate tumours having better clinical outcomes than PZ and CZ tumours. Molecular and cell biological studies can improve understanding of the unique molecular, genomic and zonal cell type features that underlie the differences in tumour progression and aggression between the zones. The unique biology of each zonal tumour type could help to guide individualized treatment and patient risk stratification.

Key points

  • The prostate is divided into three glandular zones — the peripheral, transition and central zones — each having a different prostate cancer incidence and prognosis.

  • Differences in histology and molecular profiling between the prostate zones highlight their potential role in tumour aggressiveness.

  • Peripheral zone tumours are associated with poorer pathological features and clinical outcomes than transition zone tumours.

  • Despite the differences reported, treatment of prostate cancer remains zonal agnostic.

  • An improved biological understanding of prostate zones and their roles in tumorigenesis could improve prostate cancer management in clinics.

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Fig. 1: Anatomy of the non-malignant prostate gland and tumour location according to zones.
Fig. 2: Stromal band as a border between the peripheral and transition zones.
Fig. 3: Graphic summary of the current understanding of peripheral zone and transition zone prostate cancer.
Fig. 4
Fig. 5: Zone-specific risk stratification working model.

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Acknowledgements

This research was supported by funds from CRUK Manchester Institute to E.B. and R.G.B. (C5759/A20971), and by funds from Prostate Cancer UK-Movember Prostate Cancer Centre of Excellence grant (CE013_2-004). A.A. is supported by CRUK via funding to the Cancer Research Manchester Centre (C147/A25254) and the Ministry of Health of Malaysia. A.C. and R.G.B. are supported by the NIHR Manchester Biomedical Research Centre.

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Authors and Affiliations

  1. Prostate Oncobiology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK

    Amin Ali, Alexander Du Feu & Esther Baena

  2. The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK

    Amin Ali, Pedro Oliveira, Ananya Choudhury & Robert G. Bristow

  3. The University of Manchester, Manchester Cancer Research Centre, Manchester, UK

    Ananya Choudhury & Robert G. Bristow

  4. Belfast-Manchester Movember Centre of Excellence, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK

    Ananya Choudhury, Robert G. Bristow & Esther Baena

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A.A., A.D.F. and E.B. researched data for the article and wrote the mansucript. All authors made substantial contributions to discussions of content and P.O., A.C., R.G.B. and E.B. reviewed and edited the manuscript before submission.

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Ali, A., Du Feu, A., Oliveira, P. et al. Prostate zones and cancer: lost in transition?. Nat Rev Urol 19, 101–115 (2022). https://doi.org/10.1038/s41585-021-00524-7

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