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Cui Y, Lin J, Sun D, Zhang H, Diao T, Fu Q. Nomogram for predicting the overall survival and cancer-specific survival of patients with intraductal carcinoma of the prostate. J Cancer Res Clin Oncol 2024; 150:45. [PMID: 38281261 PMCID: PMC10822789 DOI: 10.1007/s00432-023-05582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Intraductal carcinoma of the prostate (IDC-P) is a histological subtype that differs from conventional acinar adenocarcinoma in terms of its origin, appearance, and pathological features. For IDC-P, there is currently no recognized best course of action, and its prognosis is unclear. The goal of this study is to analyze independent prognostic factors in IDC-P patients and to develop and validate a nomogram to predict overall survival (OS) and cancer-specific survival (CSS). METHODS Clinical data for IDC-P patients were collected from the Surveillance, Epidemiology, and End Results database. To identify the independent variables influencing prognosis, multivariate Cox regression analysis was performed. A nomogram model was created utilizing these variables after comparing the variations in OS and CSS among various subgroups using Kaplan‒Meier curves. Internal validation of the nomograms was verified using the bootstrap resampling method. RESULTS The study included 280 IDC-P patients in total. Marital status, summary stage, grade, and the presence of lung metastases were significant factors impacting OS, and CSS was significantly influenced by marital status, summary stage, AJCC stage, the presence of lung metastases, the presence of bone metastases, and PSA according to univariate and multivariate Cox regression models (P < 0.05). Nomogram models were created to estimate OS and CSS using these parameters. The OS prediction model's C-index was 0.744, whereas the CSS prediction model's C-index was 0.831. CONCLUSION We developed and verified nomogram models for the prediction of 1-, 3-, and 5-year OS and CSS in patients with IDC-P. These nomograms serve as a resource for evaluating patient prognosis, therapy, and diagnosis, ultimately improving clinical decision-making accuracy.
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Affiliation(s)
- Yongqiang Cui
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Junyang Lin
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Dingqi Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Hui Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China
| | - Tongxiang Diao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China.
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Rd, Jinan, 250021, Shandong, China.
- Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China.
- Key Laboratory of Urinary Diseases in Universities of Shandong Shandong First Medical University, Jinan, 250021, China.
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Naito Y, Kato M, Nagayama J, Sano Y, Matsuo K, Inoue S, Sano T, Ishida S, Matsukawa Y, Tsuzuki T, Akamatsu S. Recent insights on the clinical, pathological, and molecular features of intraductal carcinoma of the prostate. Int J Urol 2024; 31:7-16. [PMID: 37728330 DOI: 10.1111/iju.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
Intraductal carcinoma of the prostate, a unique histopathologic entity that is often observed (especially in advanced prostate cancer), is characterized by the proliferation of malignant cells within normal acini or ducts surrounded by a basement membrane. Intraductal carcinoma of the prostate is almost invariably associated with an adjacent high-grade carcinoma and is occasionally observed as an isolated subtype. Intraductal carcinoma of the prostate has been demonstrated to be an independent poor prognostic factor for all stages of cancer, whether localized, de novo metastatic, or castration-resistant. It also has a characteristic genetic profile, including high genomic instability. Recognizing and differentiating it from other pathologies is therefore important in patient management, and morphological diagnostic criteria for intraductal carcinoma of the prostate have been established. This review summarizes and outlines the clinical and pathological features, differential diagnosis, molecular aspects, and management of intraductal carcinoma of the prostate, as described in previous studies. We also present a discussion and future perspectives regarding intraductal carcinoma of the prostate.
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Affiliation(s)
- Yushi Naito
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Jun Nagayama
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuta Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuna Matsuo
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Inoue
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoyasu Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shohei Ishida
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Shusuke Akamatsu
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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3
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Aiyer KTS, Kroon LJ, van Leenders GJLH. Impact of comedonecrosis on prostate cancer outcome: a systematic review. Histopathology 2023; 83:339-347. [PMID: 37195595 DOI: 10.1111/his.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
Cribriform architecture has been recognised as an independent parameter for prostate cancer outcome. Little is yet known on the added value of individual Gleason 5 growth patterns. Comedonecrosis is assigned Gleason pattern 5 and can occur in both invasive and intraductal carcinoma. The aim of this study is to systematically review the literature for the prognostic value of comedonecrosis in prostate cancer. A systematic literature search of Medline, Web of Science, Cochrane library and Google scholar was performed according to the Preferred reporting items for systematic reviews and meta-analysis (PRISMA)guidelines. After identification and screening of all relevant studies published up to July 2022, 12 manuscripts were included. Clinicopathological data were extracted and the presence of comedonecrosis in either invasive, intraductal or ductal carcinoma was associated with at least one clinical outcome measure. No meta-analysis was performed. Eight of 11 studies showed that comedonecrosis was significantly associated with biochemical recurrence and two studies with metastasis or death. The only studies using metastasis-free and disease specific-free survival as an endpoint both found comedonecrosis to be an independent prognostic parameter in multivariate analysis. The studies were all retrospective and demonstrated considerable heterogeneity with regard to clinical specimen, tumour type, grade group, correction for confounding factors and endpoints. This systematic review demonstrates weak evidence for comedonecrosis to be associated with adverse prostate cancer outcome. Study heterogeneity and lack of correction for confounding factors prohibit drawing of definitive conclusions.
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Affiliation(s)
- Kaveri T S Aiyer
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Lisa J Kroon
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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Wang Y, Teramoto Y, Miyamoto H. Comedonecrosis within conventional prostatic adenocarcinoma vs. intraductal carcinoma of the prostate: their clinical significance is not comparable. Hum Pathol 2023; 138:112-120. [PMID: 37364826 DOI: 10.1016/j.humpath.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
It remains controversial if Gleason grade should be assigned to intraductal carcinoma of the prostate (IDC-P) and if the prognostic value of comedonecrosis associated with IDC-P is equivalent to that in conventional/invasive prostatic adenocarcinoma (CPA) as a Gleason grade 5 pattern. We herein assessed radical prostatectomy findings and postoperative outcomes in 287 patients with CPA exhibiting any Gleason pattern 5. Our cases were divided into 4 cohorts according to the absence or presence of necrosis within CPA and/or IDC-P: Cohort-1) no necrosis in CPA/IDC-P (n = 179; 62.4%); Cohort-2) necrosis only in CPA (n = 25; 8.7%); Cohort-3) necrosis only in IDC-P (n = 62; 21.6%); and Cohort-4) necrosis in both CPA and IDC-P (n = 21; 7.3%). Univariate analysis revealed patients with necrosis only in IDC-P (P < .001) or both CPA and IDC-P (P = .001) had a higher risk of progression than those with necrosis only in CPA, while the prognosis was comparable between the no necrosis group vs. the CPA only necrosis group (P = .680) or the IDC-P only necrosis group vs. the CPA/IDC-P necrosis group (P = .715). In a subgroup of patients exhibiting IDC-P (n = 198), the presence of IDC-P necrosis was still associated with a significantly higher progression risk, compared with CPA necrosis only. In multivariable analysis, necrosis only in IDC-P (vs. necrosis only in CPA) showed significantly worse progression-free survival (HR = 3.193, P = .003). IDC-P necrosis, as an independent predictor, was thus found to be associated with significantly worse oncologic outcomes, compared with necrosis only in CPA, and might therefore be better not to be simply considered as a grade 5 pattern.
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Affiliation(s)
- Ying Wang
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Yuki Teramoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA; Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Diop MK, Molina OE, Birlea M, LaRue H, Hovington H, Têtu B, Lacombe L, Bergeron A, Fradet Y, Trudel D. Leukocytic Infiltration of Intraductal Carcinoma of the Prostate: An Exploratory Study. Cancers (Basel) 2023; 15:cancers15082217. [PMID: 37190147 DOI: 10.3390/cancers15082217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Intraductal carcinoma of the prostate (IDC-P) is an aggressive histological subtype of prostate cancer (PCa) detected in approximately 20% of radical prostatectomy (RP) specimens. As IDC-P has been associated with PCa-related death and poor responses to standard treatment, the purpose of this study was to explore the immune infiltrate of IDC-P. Hematoxylin- and eosin-stained slides from 96 patients with locally advanced PCa who underwent RP were reviewed to identify IDC-P. Immunohistochemical staining of CD3, CD8, CD45RO, FoxP3, CD68, CD163, CD209 and CD83 was performed. For each slide, the number of positive cells per mm2 in the benign tissues, tumor margins, cancer and IDC-P was calculated. Consequently, IDC-P was found in a total of 33 patients (34%). Overall, the immune infiltrate was similar in the IDC-P-positive and the IDC-P-negative patients. However, FoxP3+ regulatory T cells (p < 0.001), CD68+ and CD163+ macrophages (p < 0.001 for both) and CD209+ and CD83+ dendritic cells (p = 0.002 and p = 0.013, respectively) were less abundant in the IDC-P tissues compared to the adjacent PCa. Moreover, the patients were classified as having immunologically "cold" or "hot" IDC-P, according to the immune-cell densities averaged in the total IDC-P or in the immune hotspots. The CD68/CD163/CD209-immune hotspots predicted metastatic dissemination (p = 0.014) and PCa-related death (p = 0.009) in a Kaplan-Meier survival analysis. Further studies on larger cohorts are necessary to evaluate the clinical utility of assessing the immune infiltrate of IDC-P with regards to patient prognosis and the use of immunotherapy for lethal PCa.
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Affiliation(s)
- Mame-Kany Diop
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (axe Cancer) and Institut du Cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada
- Department of Pathology and Cellular Biology, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada
| | - Oscar Eduardo Molina
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
| | - Mirela Birlea
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (axe Cancer) and Institut du Cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Hélène LaRue
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
| | - Hélène Hovington
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
| | - Bernard Têtu
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
- Department of Pathology, CHU de Québec-Université Laval, 11 Côte du Palais, Québec, QC G1R 2J6, Canada
| | - Louis Lacombe
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
- Department of Surgery, Université Laval, 2325 rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Alain Bergeron
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
- Department of Surgery, Université Laval, 2325 rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Yves Fradet
- Centre de Recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L'Hôtel-Dieu de Québec, 9 McMahon, Québec, QC G1R 3S3, Canada
- Department of Surgery, Université Laval, 2325 rue de l'Université, Québec, QC G1V 0A6, Canada
| | - Dominique Trudel
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (axe Cancer) and Institut du Cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada
- Department of Pathology and Cellular Biology, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet, Montréal, QC H2X 0C1, Canada
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Yang Y, Zhang W, Wan L, Tang Z, Zhang Q, Bai Y, Zhang D. Construction and validation of a clinical predictive nomogram for intraductal carcinoma of the prostate based on Chinese multicenter clinical data. Front Oncol 2022; 12:1074478. [PMID: 36591521 PMCID: PMC9798232 DOI: 10.3389/fonc.2022.1074478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Intraductal carcinoma of the prostate (IDC-P) is a special pathological type of prostate cancer that is highly aggressive with poor prognostic outcomes. Objective To establish an effective predictive model for predicting IDC-P. Methods Data for 3185 patients diagnosed with prostate cancer at three medical centers in China from October 2012 to April 2022 were retrospectively analyzed. One cohort (G cohort) consisting of 2384 patients from Zhejiang Provincial People's Hospital was selected for construction (Ga cohort) and internal validate (Gb cohort)of the model. Another cohort (I cohort) with 344 patients from Quzhou People's Hospital and 430 patients from Jiaxing Second People's Hospital was used for external validation. Univariate and multivariate binary logistic regression analyses were performed to identify the independent predictors. Then, the selected predictors were then used to establish the predictive nomogram. The apparent performance of the model was evaluated via externally validated. Decision curve analysis was also performed to assess the clinical utility of the developed model. Results Univariate and multivariate logistic regression analyses showed that alkaline phosphatase (ALP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), prostate specific antigen (PSA) and lactate dehydrogenase were independent predictors of IDC-P. Therefore, a predictive nomogram of IDC-P was constructed. The nomogram had a good discriminatory power (AUC = 0.794). Internal validation (AUC = 0.819)and external validation (AUC = 0.903) also revealed a good predictive ability. Calibration curves showed good agreement between the predicted and observed incidences of IDC-P. Conclusion We developed a clinical predictive model composed of alkaline phosphatase (ALP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), prostate specific antigen (PSA) and lactate dehydrogenase (LDH) with a high precision and universality. This model provides a novel calculator for predicting the diagnosis of IDC-P and different treatment options for patients at an early stage.
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Affiliation(s)
- YunKai Yang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China,The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Zhejiang Provincial People’s Hospital, Qingdao University, Shandong, Qingdao, China
| | - LiJun Wan
- Department of Urology, Quzhou People’s Hospital, Quzhou, Zhejiang, China
| | - ZhiLing Tang
- Department of Urology, Jiaxing Second People’s Hospital, Jiaxing, Zhejiang, China
| | - Qi Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China
| | - YuChen Bai
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China,*Correspondence: YuChen Bai, ; DaHong Zhang,
| | - DaHong Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China,The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,*Correspondence: YuChen Bai, ; DaHong Zhang,
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Russell DH, Epstein JI. Intraductal Adenocarcinoma of the Prostate With Cribriform or Papillary Ductal Morphology: Rare Biopsy Cases Lacking Associated Invasive High-grade Carcinoma. Am J Surg Pathol 2022; 46:233-240. [PMID: 34619708 DOI: 10.1097/pas.0000000000001819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prostatic duct adenocarcinoma, characterized by pseudostratified columnar epithelium, has historically been considered invasive carcinoma, although it may commonly have an intraductal component. Usual (acinar) intraductal carcinoma of the prostate (IDC-P) is a noninvasive high-risk lesion typically associated with high-grade, high-stage prostate cancer. Whereas there have been rare biopsy studies of pure acinar IDC-P or IDC-P associated with only low-grade carcinoma, there have been no analogous series of IDC-P with cribriform or papillary ductal morphology on biopsy unassociated with invasive high-grade carcinoma. We identified 14 patients with biopsies showing IDC-P with ductal morphology, defined as prostatic duct adenocarcinoma confined to glands/ducts with immunohistochemically proven retention of basal cells. Our series includes 12 patients with pure IDC-P and 2 patients with concurrent low-volume Grade Group 1 invasive cancer in unassociated cores. Three patients underwent radical prostatectomy: 2/3 had high-grade cancer in their resection specimen (Grade Group 3, Grade Group 5), including 1 with advanced stage and nodal metastases; 1/3 had Grade Group 1 organ-confined carcinoma and spatially distinct IDC-P with ductal morphology. Five men had only follow-up biopsies: 2/5 had cancer (Grade Group 2, Grade Group 4); 1/5 had IDC-P (on 2 repeat biopsies); and 2/5 had benign transurethral resection of the prostate. In all 5 cases with invasive cancer, the invasive portion was comprised purely of acinar morphology; no invasive ductal component was identified. Five patients did not have follow-up biopsies and were treated with radiation therapy±androgen deprivation. One patient had no follow-up information. In an analogous situation to acinar IDC-P, we propose that rarely there is a precursor form of ductal adenocarcinoma that can exist without concurrent invasive high-grade carcinoma and propose the term "IDC-P with ductal morphology," consistent with the terminology for acinar prostate adenocarcinoma. Until more evidence is accumulated, we recommend reporting and treating patients with IDC-P with ductal morphology in a manner analogous to those with acinar IDC-P. As with pure IDC-P with acinar morphology, we would also recommend not grading pure IDC-P with ductal morphology. Finally, we propose a new addition to the diagnostic criteria of IDC-P to include intraductal lesions with ductal morphology consisting of papillary fronds or cribriform lesions lined by cytologically atypical pseudostratified epithelium.
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Affiliation(s)
| | - Jonathan I Epstein
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
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Diop MK, Albadine R, Kougioumoutzakis A, Delvoye N, Hovington H, Bergeron A, Fradet Y, Saad F, Trudel D. Identification of Morphologic Criteria Associated with Biochemical Recurrence in Intraductal Carcinoma of the Prostate. Cancers (Basel) 2021; 13:6243. [PMID: 34944863 PMCID: PMC8699439 DOI: 10.3390/cancers13246243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Intraductal carcinoma of the prostate (IDC-P) is an aggressive subtype of prostate cancer strongly associated with an increased risk of biochemical recurrence (BCR). However, approximately 40% of men with IDC-P remain BCR-free five years after radical prostatectomy. In this retrospective multicenter study, we aimed to identify histologic criteria associated with BCR for IDC-P lesions. A total of 108 first-line radical prostatectomy specimens were reviewed. In our test cohort (n = 39), presence of larger duct size (>573 µm in diameter), cells with irregular nuclear contours (CINC) (≥5 CINC in two distinct high-power fields), high mitotic score (>1.81 mitoses/mm2), blood vessels, and comedonecrosis were associated with early BCR (<18 months) (p < 0.05). In our validation cohort (n = 69), the presence of CINC or blood vessels was independently associated with an increased risk of BCR (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.09-4.96, p = 0.029). When combining the criteria, the presence of any CINC, blood vessels, high mitotic score, or comedonecrosis showed a stronger association with BCR (HR 2.74, 95% CI 1.21-6.19, p = 0.015). Our results suggest that IDC-P can be classified as low versus high-risk of BCR. The defined morphologic criteria can be easily assessed and should be integrated for clinical application following validation in larger cohorts.
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Affiliation(s)
- Mame-Kany Diop
- Centre de recherche du Centre hospitalier de l’Université de Montréal (axe Cancer) and Institut du cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada; (M.-K.D.); (N.D.); (F.S.)
- Department of Pathology and Cellular Biology, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal, QC H3T 1J4, Canada;
| | - Roula Albadine
- Department of Pathology and Cellular Biology, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal, QC H3T 1J4, Canada;
- Department of Pathology, Centre hospitalier de l’Université de Montréal, 1051 Sanguinet, Montréal, QC H2X 0C1, Canada;
| | - André Kougioumoutzakis
- Department of Pathology, Centre hospitalier de l’Université de Montréal, 1051 Sanguinet, Montréal, QC H2X 0C1, Canada;
| | - Nathalie Delvoye
- Centre de recherche du Centre hospitalier de l’Université de Montréal (axe Cancer) and Institut du cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada; (M.-K.D.); (N.D.); (F.S.)
| | - Hélène Hovington
- Laboratoire d’Uro-Oncologie Expérimentale, Centre de recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L’Hôtel-Dieu de Québec, 10 McMahon, Québec City, QC G1R 3S1, Canada; (H.H.); (A.B.); (Y.F.)
| | - Alain Bergeron
- Laboratoire d’Uro-Oncologie Expérimentale, Centre de recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L’Hôtel-Dieu de Québec, 10 McMahon, Québec City, QC G1R 3S1, Canada; (H.H.); (A.B.); (Y.F.)
- Department of Surgery, Université Laval, 2325 rue de l’Université, Québec City, QC G1V 0A6, Canada
| | - Yves Fradet
- Laboratoire d’Uro-Oncologie Expérimentale, Centre de recherche du CHU de Québec-Université Laval (axe Oncologie), Hôpital L’Hôtel-Dieu de Québec, 10 McMahon, Québec City, QC G1R 3S1, Canada; (H.H.); (A.B.); (Y.F.)
- Department of Surgery, Université Laval, 2325 rue de l’Université, Québec City, QC G1V 0A6, Canada
| | - Fred Saad
- Centre de recherche du Centre hospitalier de l’Université de Montréal (axe Cancer) and Institut du cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada; (M.-K.D.); (N.D.); (F.S.)
- Department of Urology, Centre hospitalier de l’Université de Montréal, 1051 Sanguinet, Montréal, QC H2X 0C1, Canada
| | - Dominique Trudel
- Centre de recherche du Centre hospitalier de l’Université de Montréal (axe Cancer) and Institut du cancer de Montréal, 900 Saint-Denis, Montréal, QC H2X 0A9, Canada; (M.-K.D.); (N.D.); (F.S.)
- Department of Pathology and Cellular Biology, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montreal, QC H3T 1J4, Canada;
- Department of Pathology, Centre hospitalier de l’Université de Montréal, 1051 Sanguinet, Montréal, QC H2X 0C1, Canada;
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9
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Wang Z, Zhu S, Zhao J, Nie L, Chen X, Zhang M, Chen N, Sun G, Chen J, Ni Y, Dai J, Liu Z, Tao R, Zhang X, Zhu X, Zhang H, Liang J, Wang Z, He B, Shen P, Zeng H. The heterogeneity of intraductal carcinoma of the prostate is associated with different efficacy of standard first-line therapy for patients with metastatic castration-resistant prostate cancer. Prostate 2021; 81:1191-1201. [PMID: 34435696 PMCID: PMC9290811 DOI: 10.1002/pros.24215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/16/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To explore whether metastatic castration-resistant prostate cancer (mCRPC) patients with distinct intraductal carcinoma of the prostate (IDC-P) subtypes respond differently to abiraterone and docetaxel treatment. METHODS We retrospectively analyzed data of 170 mCRPC patients receiving abiraterone or docetaxel as first-line therapy. PSA response, PSA progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival (OS) were analyzed based on the presence of IDC-P and its subpatterns. RESULTS IDC-P was confirmed in 91/170 (53.5%) patients. Among them 36/91 (39.6%) and 55/91 (60.4%) harbored IDC-P patterns 1 and 2, respectively. Patients with IDC-P pattern 1 shared similar clinical outcomes to those without IDC-P in both abiraterone and docetaxel treatment. However, against cases without IDC-P or with IDC-P pattern 1, patients with IDC-P pattern 2 had markedly poorer prognosis in either abiraterone (mPSA-PFS: 11.9 vs. 11.1 vs. 6.1 months, p < 0.001; mrPFS: 18.9 vs. 19.4 vs. 9.6 months, p < 0.001) or docetaxel (mPSA-PFS: 6.2 vs. 6.6 vs. 3.0 months, p < 0.001; mrPFS: 15.1 vs. 12.6 vs. 5.5 months, p < 0.001) treatment. For patients without IDC-P, docetaxel had comparable therapeutic efficacy with abiraterone. However, the efficacy of docetaxel was significantly inferior to abiraterone in patients with either IDC-P pattern 1 (mPSA-PFS: 6.6 vs. 11.1 months, p = 0.021; mrPFS: 12.6 vs. 19.4 months, p = 0.027) or pattern 2 (mPSA-PFS: 3.0 vs. 6.1 months, p = 0.003; mrPFS: 5.5 vs. 9.6 months, p = 0.007). CONCLUSION Compared to docetaxel, abiraterone exhibited better efficacy in patients with IDC-P of either pattern. However, IDC-P pattern 2 responded unsatisfactorily to either abiraterone or docetaxel therapy. Novel therapeutic strategies for IDC-P pattern 2 need further investigations.
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Affiliation(s)
- Zhipeng Wang
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Sha Zhu
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Jinge Zhao
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Ling Nie
- Department of Pathology, West China HospitalSichuan UniversityChengduChina
| | - Xueqin Chen
- Department of Pathology, West China HospitalSichuan UniversityChengduChina
| | - Mengni Zhang
- Department of Pathology, West China HospitalSichuan UniversityChengduChina
| | - Ni Chen
- Department of Pathology, West China HospitalSichuan UniversityChengduChina
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Junru Chen
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Yuchao Ni
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Ronggui Tao
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Xudong Zhu
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Haoran Zhang
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Jiayu Liang
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Zilin Wang
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Ben He
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
- Department of UrologyThe Third People's Hospital of ChengduChengduChina
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China HospitalSichuan UniversityChengduChina
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10
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Zhu S, Zhao JG, Chen JR, Liu ZH, Sun GX, Wang ZP, Ni YC, Dai JD, Shen PF, Zeng H. Intraductal carcinoma of the prostate in prostate biopsy samples: correlation with aggressive pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer. Asian J Androl 2021; 22:519-525. [PMID: 31710002 PMCID: PMC7523608 DOI: 10.4103/aja.aja_117_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Intraductal carcinoma of the prostate (IDC-P) is an aggressive pathological pattern of prostate cancer (PCa). We investigated the association of IDC-P in prostate biopsy (PBx) with several pathological features after radical prostatectomy (RP) and its prognostic value in high-risk PCa. A total of 418 patients with high-risk PCa after RP were included in this study. IDC-P and its architectural patterns were identified according to the 2016 World Health Organization Classification. Chi-squared test and logistic regression were used to investigate the correlation between IDC-P and post-RP pathological features. Kaplan–Meier curves and Cox regression were applied to explore the prognostic value of IDC-P. IDC-P was identified in PBx in 36/418 (8.6%) patients. Logistic regression indicated that IDC-P in PBx was independently associated with several pathological features of RP, including Gleason score 8–10 (P < 0.001), seminal vesicular invasion (P < 0.001), and pathological T (pT) 3a (P = 0.043). Patients with IDC-P in PBx manifested poorer biochemical-free survival (BFS) than those without IDC-P (37.47 months vs not reached, P < 0.001). The addition of IDC-P in several prognostic nomograms could improve the predictive accuracy of these tools. We conclude that IDC-P in PBx is positively associated with several aggressive pathological features after RP in high-risk PCa. In addition, IDC-P in PBx could effectively predict the BFS of high-risk PCa patients after RP.
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Affiliation(s)
- Sha Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin-Ge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jun-Ru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhen-Hua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guang-Xi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Peng Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu-Chao Ni
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin-Dong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Peng-Fei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
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11
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Considine B, Adeniran A, Hurwitz ME. Current Understanding and Management of Intraductal Carcinoma of the Prostate. Curr Oncol Rep 2021; 23:110. [PMID: 34272624 DOI: 10.1007/s11912-021-01090-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This review will discuss current understanding and management approaches of Intraductal carcinoma of the prostate (IDC-P). IDC-P is a histological finding characterized by neoplastic cells that expand but do not invade prostate ducts. RECENT FINDINGS The presence of IDC-P on a prostate biopsy is almost always associated with an invasive disease component and is independently associated with worse clinical outcomes in both early and late disease. These tumors are enriched for mutations in homologous DNA recombination repair (HRR) leading to high genomic instability. Multiparametric MRI with targeted biopsy may aid in diagnosis. Given the poor clinical outcomes associated with this histologic entity, its presence in biopsies should warrant consideration of aggressive management.
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Affiliation(s)
- Bryden Considine
- Yale Comprehensive Cancer Center, 333 Cedar St, New Haven, CT, 06510, USA
| | - Adebowale Adeniran
- Yale Comprehensive Cancer Center, 333 Cedar St, New Haven, CT, 06510, USA
| | - Michael E Hurwitz
- Yale Comprehensive Cancer Center, 333 Cedar St, New Haven, CT, 06510, USA.
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12
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Lawrence MG, Porter LH, Clouston D, Murphy DG, Frydenberg M, Taylor RA, Risbridger GP. Knowing what's growing: Why ductal and intraductal prostate cancer matter. Sci Transl Med 2021; 12:12/533/eaaz0152. [PMID: 32132214 DOI: 10.1126/scitranslmed.aaz0152] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
Prostate cancer is a common malignancy, but only some tumors are lethal. Accurately identifying these tumors will improve clinical practice and instruct research. Aggressive cancers often have distinctive pathologies, including intraductal carcinoma of the prostate (IDC-P) and ductal adenocarcinoma. Here, we review the importance of these pathologies because they are often overlooked, especially in genomics and preclinical testing. Pathology, genomics, and patient-derived models show that IDC-P and ductal adenocarcinoma accompany multiple markers of poor prognosis. Consequently, "knowing what is growing" will help translate preclinical research to pinpoint and treat high-risk prostate cancer in the clinic.
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Affiliation(s)
- Mitchell G Lawrence
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia.,Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Laura H Porter
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | | | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC 3000, Australia.,Epworth HealthCare, Melbourne, VIC 3000, Australia
| | - Mark Frydenberg
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia.,Australian Urology Associates, Melbourne, VIC 3000, Australia.,Department of Urology, Cabrini Health, Malvern, VIC 3144, Australia
| | - Renea A Taylor
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia.,Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Gail P Risbridger
- Monash Partners Comprehensive Cancer Consortium, Monash Biomedicine Discovery Institute Cancer Program, Prostate Cancer Research Group, Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia. .,Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
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13
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Presence of corpora amylacea among prostate cancer cells: an unrecognised feature of intraductal carcinoma of the prostate. Pathology 2021; 53:574-578. [PMID: 34154844 DOI: 10.1016/j.pathol.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022]
Abstract
Corpora amylacea (CA) is usually present in benign prostatic ducts and acini, and its presence is considered suggestive of negative or low-risk prostate cancer. The clinicopathological definition of CA among prostate cancer cells (CAPCCs)-described as CA entirely surrounded by invasive cancer cells-has not been discussed. As intraductal carcinoma of the prostate (IDC-P) is a well-known adverse prognostic factor in prostate cancer, this study aimed to elucidate the relationship between CAPCC and IDC-P. We enrolled 366 patients who underwent robotic-assisted radical prostatectomies between 2012 and 2018 at Aichi Medical University Hospital. All surgical specimens were independently reviewed by two genitourinary pathologists. The median age of the patients was 68.5 years; the median serum prostate-specific antigen was 6.49 ng/mL. IDC-P was observed in 143 (39.1%) patients, while the presence of CAPCC was observed in 47 cases (12.8%). Patients with CAPCC were associated with more advanced clinical and pathological T stages, as well as Gleason scores, than those without CAPCC (p=0.018, p<0.001, p=0.036). Notably, the presence of CAPCC was significantly associated with the presence of IDC-P (39 cases) and a high Gleason score compared with the absence of CAPCC (12 cases) (p<0.001 and p=0.036, respectively). The presence of CAPCC is an adverse pathological feature, often closely related to IDC-P. Therefore, CAPCC may be a surrogate finding to detect IDC-P via haematoxylin and eosin staining.
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14
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Epstein JI, Amin MB, Fine SW, Algaba F, Aron M, Baydar DE, Beltran AL, Brimo F, Cheville JC, Colecchia M, Comperat E, da Cunha IW, Delprado W, DeMarzo AM, Giannico GA, Gordetsky JB, Guo CC, Hansel DE, Hirsch MS, Huang J, Humphrey PA, Jimenez RE, Khani F, Kong Q, Kryvenko ON, Kunju LP, Lal P, Latour M, Lotan T, Maclean F, Magi-Galluzzi C, Mehra R, Menon S, Miyamoto H, Montironi R, Netto GJ, Nguyen JK, Osunkoya AO, Parwani A, Robinson BD, Rubin MA, Shah RB, So JS, Takahashi H, Tavora F, Tretiakova MS, True L, Wobker SE, Yang XJ, Zhou M, Zynger DL, Trpkov K. The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer. Arch Pathol Lab Med 2021; 145:461-493. [PMID: 32589068 DOI: 10.5858/arpa.2020-0015-ra] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Controversies and uncertainty persist in prostate cancer grading. OBJECTIVE.— To update grading recommendations. DATA SOURCES.— Critical review of the literature along with pathology and clinician surveys. CONCLUSIONS.— Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 + 4 = 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace "tertiary grade pattern" in radical prostatectomy (RP) with "minor tertiary pattern 5 (TP5)," and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)-targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 + 5 = 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (>50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) "atypical intraductal proliferation (AIP)" is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.
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Affiliation(s)
- Jonathan I Epstein
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada.,Urology (Epstein), David Geffen School of Medicine at UCLA, Los Angeles, California (Huang).,and Oncology (Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis (Amin)
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Fine)
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain (Algaba)
| | - Manju Aron
- Department of Pathology, University of Southern California, Los Angeles (Aron)
| | - Dilek E Baydar
- Department of Pathology, Faculty of Medicine, Koç University, İstanbul, Turkey (Baydar)
| | - Antonio Lopez Beltran
- Department of Pathology, Champalimaud Centre for the Unknown, Lisbon, Portugal (Beltran)
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center, Montréal, Quebec, Canada (Brimo)
| | - John C Cheville
- Department of Pathology, Mayo Clinic, Rochester, Minnesota (Cheville, Jimenez)
| | - Maurizio Colecchia
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (Colecchia)
| | - Eva Comperat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France (Comperat)
| | | | | | - Angelo M DeMarzo
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada
| | - Giovanna A Giannico
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico, Gordetsky)
| | - Jennifer B Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico, Gordetsky)
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Guo)
| | - Donna E Hansel
- Department of Pathology, Oregon Health and Science University, Portland (Hansel)
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Hirsch)
| | - Jiaoti Huang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Huang)
| | - Peter A Humphrey
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Humphrey)
| | - Rafael E Jimenez
- Department of Pathology, Mayo Clinic, Rochester, Minnesota (Cheville, Jimenez)
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Khani, Robinson)
| | - Qingnuan Kong
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong, China (Kong).,Kong is currently located at Kaiser Permanente Sacramento Medical Center, Sacramento, California
| | - Oleksandr N Kryvenko
- Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (Kryvenko)
| | - L Priya Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Kunju, Mehra)
| | - Priti Lal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (Lal)
| | - Mathieu Latour
- Department of Pathology, CHUM, Université de Montréal, Montréal, Quebec, Canada (Latour)
| | - Tamara Lotan
- From the Departments of Pathology (Epstein, DeMarzo, Lotan), McGill University Health Center, Montréal, Quebec, Canada
| | - Fiona Maclean
- Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia (Maclean)
| | - Cristina Magi-Galluzzi
- Department of Pathology, The University of Alabama at Birmingham, Birmingham (Magi-Galluzzi, Netto)
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Kunju, Mehra)
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, India (Menon)
| | - Hiroshi Miyamoto
- Departments of Pathology and Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York (Miyamoto)
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy (Montironi)
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham (Magi-Galluzzi, Netto)
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Nguyen)
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia (Osunkoya)
| | - Anil Parwani
- Department of Pathology, Ohio State University, Columbus (Parwani, Zynger)
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Khani, Robinson)
| | - Mark A Rubin
- Department for BioMedical Research, University of Bern, Bern, Switzerland (Rubin)
| | - Rajal B Shah
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Shah)
| | - Jeffrey S So
- Institute of Pathology, St Luke's Medical Center, Quezon City and Global City, Philippines (So)
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan (Takahashi)
| | - Fabio Tavora
- Argos Laboratory, Federal University of Ceara, Fortaleza, Brazil (Tavora)
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle (Tretiakova, True)
| | - Lawrence True
- Department of Pathology, University of Washington School of Medicine, Seattle (Tretiakova, True)
| | - Sara E Wobker
- Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina, Chapel Hill (Wobker)
| | - Ximing J Yang
- Department of Pathology, Northwestern University, Chicago, Illinois (Yang)
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, Massachusetts (Zhou)
| | - Debra L Zynger
- Department of Pathology, Ohio State University, Columbus (Parwani, Zynger)
| | - Kiril Trpkov
- and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (Trpkov)
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15
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Grade group 2 (10% ≥ GP4) patients have very similar malignant potential with grade group 1 patients, given the risk of intraductal carcinoma of the prostate. Int J Clin Oncol 2021; 26:764-769. [PMID: 33385274 DOI: 10.1007/s10147-020-01841-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND It has been argued that grade group 2 (GG2) with a low Gleason pattern 4 (GP4) proportion should be an indication for active surveillance (AS) of prostate cancer (PCa). However, the cut-off GP4 proportion for AS remains unclear. Here, we evaluated the effect of GP4 proportion and IDC-P on cancer recurrence following radical prostatectomy (RP) in GG1 and GG2 patients, and identified candidates for AS. METHODS We retrospectively evaluated 646 patients with PCa who underwent RP between 2005 and 2014, and whose specimens were of GG1 or GG2 status. RESULTS The GGs were as follows: GG1, 25.2% (n = 163); GG2 (5% ≥ GP4), 11.4% (n = 74); GG2 (5% < GP4 ≤ 10%), 25.9% (n = 167); and GG2 (20% ≤ GP4), 37.5% (n = 242). IDC-P was detected in 26 patients (4%), i.e., in 2/167 GG2 (5% < GP4 ≤ 10%; 1%) cases and 24/242 GG2 (20% ≤ GP4; 10%) cases. GG2 patients with IDC-P exhibited a significantly poorer prognosis than did those without IDC-P (P < 0.0001), as did GG2 (20% ≤ GP4) patients without IDC-P (P < 0.05). The GG2 (5% ≥ GP4) and (5% < GP4 ≤ 10%) groups exhibited prognoses similar to those of the GG1 patients. In multivariate analysis, GG2 (20% ≤ GP4) without IDC-P, the presence of IDC-P, and the prostate-specific antigen level at diagnosis significantly predicted prognosis (P < 0.05, < 0.0001, and < 0.0001, respectively). CONCLUSION Our findings suggest that GG2 (GP4 ≤ 10%) patients could be indicated for AS, similar to GG1 patients, given the risk of IDC-P tumors.
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16
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Zhang YC, Sun GL, Ma DL, Wei C, Shang HJ, Liu Z, Li R, Wang T, Wang SG, Liu JH, Liu XM. The presence of intraductal carcinoma of the prostate is closely associated with poor prognosis: a systematic review and meta-analysis. Asian J Androl 2021; 23:103-108. [PMID: 32496222 PMCID: PMC7831822 DOI: 10.4103/aja.aja_21_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We aimed to confirm the predictive ability of the presence of intraductal carcinoma of the prostate (IDC-P) for prognosis and the associations between IDC-P and clinicopathological parameters. Studies were identified in PubMed, Cochrane Library, EMBASE, Web of Science, and SCOPUS up to December 1, 2019. Hazard ratios (HRs) for survival data and odds ratios for clinicopathological data with 95% confidence intervals (CIs) were extracted. Heterogeneity was evaluated by the I2 value, and quality was assessed by the Newcastle–Ottawa Scale criteria. A total of 4179 patients from 13 studies were included. The results showed that IDC-P presence was significantly associated with poor progression-free survival (PFS; HR = 2.31; 95% CI: 1.96–2.73), cancer-specific survival (HR = 1.89; 95% CI: 1.28–2.77), and overall survival (HR = 2.14; 95% CI: 1.53–3.01). In the subgroup analysis, IDC-P presence was significantly associated with poor PFS in prostate cancer treated by radical prostatectomy (HR = 2.48; 95% CI: 2.05–3.00) and treated by radiotherapy (HR = 2.83; 95% CI: 1.65–4.85). Regarding clinicopathological characteristics, patients with IDC-P presence had significantly higher tumor clinical stages, Gleason scores, probabilities of lymph node invasion, positive surgical margins, and positive extraprostatic extension. Our meta-analysis indicates that the presence of IDC-P is closely associated with poor prognosis and adverse clinicopathological characteristics. Our data support the value and clinical utility of the routine detection of IDC-P by pathological examination. These conclusions need further validation, and prospective studies are needed to find better treatment modalities other than traditional first-line therapy for patients with IDC-P.
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Affiliation(s)
- Yu-Cong Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Geriatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guo-Liang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - De-Lin Ma
- Department of Endocrine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chao Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hao-Jie Shang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhuo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Rui Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shao-Gang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ji-Hong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xia-Ming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Zong Y, Montironi R, Massari F, Jiang Z, Lopez-Beltran A, Wheeler TM, Scarpelli M, Santoni M, Cimadamore A, Cheng L. Intraductal Carcinoma of the Prostate: Pathogenesis and Molecular Perspectives. Eur Urol Focus 2020; 7:955-963. [PMID: 33132109 DOI: 10.1016/j.euf.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
Intraductal carcinoma of the prostate (IDC-P), a clinicopathological entity characterized by malignant prostatic epithelial cells growing within ducts and/or acini, has a distinct architectural pattern, cytological features, and biological behavior. Whereas most IDC-P tumors could be derived from adjacent high-grade invasive cancer via retrograde spreading of cancer cells along benign ducts and acini, a small subset of IDC-P may arise from the transformation and intraductal proliferation of precancerous cells induced by various oncogenic events. These isolated IDC-P tumors possess a distinct mutational profile and may function as a carcinoma in situ lesion with de novo intraductal outgrowth of malignant cells. Further molecular characterization of these two types of IDC-P and better understanding of the mechanisms underlying IDC-P formation and progression could be translated into valuable biomarkers for differential diagnosis and actionable targets for therapeutic interventions. PATIENT SUMMARY: Intraductal carcinoma of the prostate is an aggressive type of prostate cancer associated with high risk for local recurrence and distant metastasis. In this review, we discussed pathogenesis, biomarkers, differential diagnoses, and therapeutic strategies for this tumor.
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Affiliation(s)
- Yang Zong
- Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Francesco Massari
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Zhong Jiang
- Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Antonio Lopez-Beltran
- Department of Pathology and Surgery, Faculty of Medicine, Cordoba University, Cordoba, Spain
| | - Thomas M Wheeler
- Department of Pathology and Laboratory Medicine, Baylor St. Luke's Medical Center, Houston, TX, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
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18
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Downes MR, Xu B, van der Kwast TH. Cribriform architecture prostatic adenocarcinoma in needle biopsies is a strong independent predictor for lymph node metastases in radical prostatectomy. Eur J Cancer 2020; 148:432-439. [PMID: 33077335 DOI: 10.1016/j.ejca.2020.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022]
Abstract
AIM Lymph node metastases (pN1) at prostatectomy are infrequent but impact prognosis. Traditional prostate nomograms assess age, serum prostatic-specific antigen (PSA), clinical stage, and biopsy parameters to inform decisions on pelvic lymph node dissection. The impact of intraductal carcinoma (IDC) and cribriform pattern 4 (CC) on nodal metastases has yet to be explored. METHODS Five hundred forty three radical prostatectomy cases were reviewed for International Society of Urological Pathology (ISUP) grade, CC/IDC, T- and N-stage. Two hundred seventy five cases had matched biopsies with age, serum PSA, CC/IDC and ISUP grade recorded. The association of CC/IDC with pN1 in both prostatectomy and biopsy settings was assessed using Fisher's exact test, as well as univariable (UVA) and multivariable (MVA) logistic regression. RESULTS In 543 men in whom a prostatectomy was performed, a nodal dissection was also available in 340 (63%), and 37 (10.9%) of them had pN1 disease. ISUP grade, stage and CC/IDC were significantly associated with pN1 (p < 0.001). UVA regression showed grade (p < 0.001, odds ratio [OR]: 5.85), CC/IDC (p = 0.003, OR: 14.06) and T stage (p = 0.004, OR: 61.94) associated with pN1 as did MVA regression: grade (p = 0.010, OR: 2.81), CC/IDC (p = 0.015, OR: 5.12) and T stage (p = 0.016, OR: 30.38). In 275 patients with matched biopsies, a nodal dissection was performed in 197 (71.6%) and 20 (10.2%) patients had pN1 disease. On UVA regression, grade (p < 0.001, OR: 6.33), CC/IDC (p = 0.013, OR: 3.28), serum PSA (p = 0.001, OR: 1.08) and age (p = 0.047, OR: 1.07) were significant for pN1 at prostatectomy. All parameters including specifically grade (p = 0.007, OR: 5.35) and CC/IDC (p = 0.018, OR: 4.42) on biopsies predicted for pN1 by multivariate analysis. CONCLUSION CC/IDC in prostatectomy and biopsy significantly associates with pN1. Incorporation of CC/IDC status into preoperative nomograms may optimize patient selection for pelvic nodal dissection.
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Affiliation(s)
- Michelle R Downes
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Intraductal carcinoma of the prostate (IDC-P) is a diagnostic entity characterized by architecturally or cytologically malignant-appearing prostatic glandular epithelium confined to prostatic ducts. Despite its apparent in situ nature, this lesion is associated with aggressive prostatic adenocarcinoma and is a predictor for poor prognosis when identified on biopsy or radical prostatectomy. This review discusses diagnosis, clinical features, histogenesis, and management of IDC-P, as well as current research and controversies surrounding this entity.
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20
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Haroon UM, O'Grady-Coyne S, Davis NF, Gullmann C, Forde JC, Smyth GP, Power RE, Cheema IA, McLornan L. Intraductal carcinoma of the prostate in an Irish prostate cancer patient cohort-an aggressive pathology and a strong familial link. Prostate Int 2020; 8:107-111. [PMID: 33102390 PMCID: PMC7557169 DOI: 10.1016/j.prnil.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Abstract
Background The prevalence of intraductal carcinoma of the prostate (IDC-P) is poorly studied in the Irish population. This study investigated the incidence and clinicopathologic characteristics of IDC-P in an Irish prostate cancer (PCa) patient cohort. The study also discusses the rationale for genetic counseling and screening in Irish patients with familial risk factors for IDC-P. Materials and methods This study investigated patients diagnosed with IDC-P on prostate biopsy from 2012 to 2016. Primary outcome measurements were incidence, management, and clinical outcomes after follow-up in patients with IDC-P. The secondary outcome measurement was to identify a familial link for IDC-P. Results A total of 1,143 patients were diagnosed with PCa on needle biopsy, of which 30 (2.3%) had concomitant IDC-P. Mean age and prostate-specific antigen at diagnosis were 68.6 ± 10.5 years (range 53–85 years) and 9.15 ± 8.65 ng/mL (range 2.1–166 ng/mL), respectively. In total, 17 of 30 patients (57%) were diagnosed with concomitant high-grade (i.e., ≥Gleason score 8) PCa. Eight patients (27%) were treated with radical prostatectomy; of which five had biochemical recurrence (BCR) after 10.55 ± 25.9 months. Eleven patients (37%) received radical radiotherapy; of which one had BCR after 36 months. Eleven patients (37%) presented with advanced PCa and were managed with androgen deprivation therapy ± chemotherapy. A family history for PCa in first-degree relatives was found in eight patients (27%). Conclusions IDC-P is associated with more aggressive clinicopathologic features and an increased risk of BCR after treatment. In Ireland, clinical guidelines and a genetic screening pathway are required to provide early detection and appropriate multimodal management of patients with IDC-P.
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Affiliation(s)
- Usman M Haroon
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Shona O'Grady-Coyne
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Niall F Davis
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | | | - James C Forde
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Gordon P Smyth
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Richard E Power
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Ijaz A Cheema
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
| | - Liza McLornan
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
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21
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Kato M, Hirakawa A, Kobayashi Y, Yamamoto A, Ishida R, Sano T, Kimura T, Majima T, Ishida S, Funahashi Y, Sassa N, Fujita T, Matsukawa Y, Yamamoto T, Hattori R, Gotoh M, Tsuzuki T. The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance. Prostate 2019; 79:1065-1070. [PMID: 31025722 DOI: 10.1002/pros.23818] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/09/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although the presence of intraductal carcinoma of the prostate (IDC-P) influences biochemical failure in radical prostatectomy patients, no data are available regarding the impact of its integration into the classification grade group system. Thus, the aim of this study was to enhance the utility of the grade group system by integrating the presence of IDC-P. METHODS This study was a retrospective evaluation of 1019 patients with prostate cancer who underwent radical prostatectomy between 2005 and 2013 without neoadjuvant or adjuvant therapy. The data on age, prostate-specific antigen (PSA) level at diagnosis, pathological T stage (pT), presence of Gleason pattern 5 (GP5), presence of IDC-P, and surgical margin status were analyzed to predict PSA recurrence after prostatectomy. RESULTS The median patient age was 67 (range, 45-80) years and the median initial PSA level was 6.8 (range, 0.4-82) ng/mL. The median follow-up period was 82 (range, 0.7-148) months. IDC-P was detected in 157 patients (15.4%). Among these patients, the increase in the positive rate of IDC-P correlated with tumor upgrading. The grade groups (GGs) were as follows: GG1 without IDC-P, 16.0% (n = 163); GG2 without IDC-P, 46.1% (n = 470); GG3 without IDC-P, 15.7% (n = 160); GG4 without IDC-P, 2.6% (n = 27); GG5 without IDC-P, 4.1% (n = 42); any GG with IDC-P, 15.4% [n = 157; GG 2 (n = 29); GG3 (n = 60); GG4 (n = 13); GG5 (n = 55)]. Any grade Group with IDC-P showed significantly worse prognosis than any other group without IDC-P (P < 0.0001). In a multivariate analysis, integration of the IDC-P into the Grade Groups, the PSA level at diagnosis, and the surgical margin status were significant prognostic predictors (P < 0.0001, < 0.0001 and < 0.0001, respectively). CONCLUSIONS Integrating the presence of IDC-P into the grade group system will result in more accurate predictions of patient outcome.
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Affiliation(s)
- Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Kobayashi
- Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Akiyuki Yamamoto
- Department of Urology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Ryo Ishida
- Department of Urology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Tomoyasu Sano
- Department of Urology, Komaki City Hospital, Komaki, Japan
| | - Tohru Kimura
- Department of Urology, JCHO Chukyo Hospital, Nagoya, Japan
| | - Tsuyoshi Majima
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shohei Ishida
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhito Funahashi
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Fujita
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tokunori Yamamoto
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryohei Hattori
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, School of Medicine, Nagakute, Japan
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22
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[SIGNIFICANCE OF INTRADUCTAL CARCINOMA OF THE PROSTATE IN POST-OPERATIVE BIOCHEMICAL RECURRENCE]. Nihon Hinyokika Gakkai Zasshi 2019; 108:5-11. [PMID: 29367511 DOI: 10.5980/jpnjurol.108.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objective) We investigated the prognostic significance of intraductal carcinoma of the prostate (IDC-P) in radical prostatectomy specimens. (Materials and methods) We evaluated 441 patients treated with radical prostatectomy and analyzed data on IDC-P, lymph node metastases, Gleason score, seminal vesicle invasion, extraprostatic extension, surgical margin, total cancer volume, and zonal origin of dominant cancer focus in radical prostatectomy specimens. The median follow-up was 50 months (range 6-164 months). (Results) We identified IDC-P in 112 cases (25.4%). The five-year biochemical progression-free survival rate in patients with IDC-P was significantly lower than for those without IDC-P (35.8% vs 69.6%; p<0.0001). In a univariate analysis, IDC-P (p<0.0001), lymph node metastases (p=0.0022), Gleason score (p<0.0001), seminal vesicle invasion (p<0.0001), extraprostatic extension (p<0.0001), surgical margin (p<0.0001) and total cancer volume (p<0.0001) were significantly associated with the biochemical progression-free survival. In a multivariate analysis, Gleason score (p<0.0001), IDC-P (p=0.0002), seminal vesicle invasion (p=0.0011), extraprostatic extension (p=0.0012), surgical margin (p=0.0019) and lymph node metastases (p=0.0402) were significantly associated with biochemical progression-free survival. (Conclusions) The presence of IDC-P is an independent factor of biochemical recurrence in prostate cancer patients treated with radical prostatectomy. We therefore recommend that the presence of IDC-P in radical prostatectomy specimens be reported.
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23
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Acosta AM, Vormittag E, Al Rasheed MRH, Sharif A, Mon KS, Kajdacsy-Balla A, Mohapatra G. Comparison of prostatic adenocarcinoma Gleason 5 and intraductal carcinoma of the prostate with tumor necrosis. A morphometric study. Pathol Res Pract 2018; 214:1681-1685. [DOI: 10.1016/j.prp.2018.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022]
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24
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van Duijn PW, Marques RB, Ziel-van der Made ACJ, van Zoggel HJAA, Aghai A, Berrevoets C, Debets R, Jenster G, Trapman J, van Weerden WM. Tumor heterogeneity, aggressiveness, and immune cell composition in a novel syngeneic PSA-targeted Pten knockout mouse prostate cancer (MuCaP) model. Prostate 2018; 78:1013-1023. [PMID: 30133757 DOI: 10.1002/pros.23659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/09/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prostate cancer is recognized as a heterogeneous disease demanding appropriate preclinical models that reflect tumor complexity. Previously, we established the PSA-Cre;PtenLoxP/LoxP genetic engineered mouse model (GEMM) for prostate cancer reflecting the various stages of tumor development. Prostate tumors in this Pten KO model slowly develop, requiring more than 10 months. In order to enhance its practical utility, we established a syngeneic panel of cell lines derived from PSA-Cre targeted Pten KO tumors, designated the mouse prostate cancer (MuCap) model. METHODS Four different MuCaP epithelial cell lines were established from three independent primary Pten KO mouse prostate tumors. Tumorigenic capacity of the MuCaP cell lines was determined by subcutaneous inoculation of these cell lines in immunocompetent mice. Response to PI3K-targeted therapy was validated in ex vivo tissue slices of the established MuCaP tumors. RESULTS The MuCaP cell lines were all tumorigenic in immunocompetent mice after subcutaneous inoculation. Interestingly, these syngrafted tumors represented different tumor growth rates and morphologies. Treatment with the specific PI3K inhibitor GDC0941 resulted in responses very similar between syngeneic MuCaP and primary Pten KO prostate tumors. Finally, immunoprofiling of the different syngeneic MuCaP tumors demonstrated differential numbers of tumor infiltrating lymphocytes and distinct immune gene profiles with expression of CD8, INFy, and PD1 being inversely related to tumor aggressiveness. CONCLUSIONS Collectively, we present here a well-defined MuCaP platform of in vitro and in vivo mouse prostate cancer models that may support preclinical assessment of (immune)-therapies for prostate cancer.
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Affiliation(s)
- Petra W van Duijn
- Department of Pathology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Urology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rute B Marques
- Department of Urology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Ashraf Aghai
- Department of Urology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cor Berrevoets
- Department of Medical Oncology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Reno Debets
- Department of Medical Oncology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guido Jenster
- Department of Urology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Trapman
- Department of Pathology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wytske M van Weerden
- Department of Urology, JNI, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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25
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Fine SW, Al-Ahmadie HA, Chen YB, Gopalan A, Tickoo SK, Reuter VE. Comedonecrosis Revisited: Strong Association With Intraductal Carcinoma of the Prostate. Am J Surg Pathol 2018; 42:1036-1041. [PMID: 29878934 PMCID: PMC6041141 DOI: 10.1097/pas.0000000000001104] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
From the advent of the Gleason grading system for prostate cancer, cancer displaying intraluminal necrotic cells and/or karyorrhexis within cribriform/solid architecture, a phenomenon termed "comedonecrosis," has been assigned pattern 5. Intraductal carcinoma (IDC-P) shows morphologic overlap with high-grade cribriform/solid adenocarcinoma architecturally and cytologically and may also show central necrosis, yet due to the presence of basal cells at the duct periphery is not currently assigned a grade in clinical practice. On the basis of observations from routine clinical cases, we hypothesized that comedonecrosis was more significantly associated with IDC-P than invasive disease. From a large series of mapped radical prostatectomy specimens (n=933), we identified 125 high-grade (≥Gleason score 4+3=7), high-volume tumors with available slides for review. All slides were examined for the presence of unequivocal comedonecrosis. Standard immunohistochemistry for basal cell markers was performed to detect basal cell labeling in these foci. In total, 19 of 125 (15%) cases showed some ducts with comedonecrosis-9 cases with 1 focus and 10 cases with ≥2 foci; in all, a total of 73 foci of true comedonecrosis were evaluated. Immunohistochemical stains revealed labeling for basal cell markers in a basal cell distribution for at least some comedonecrosis foci in 18 of 19 (95%) cases, 12 with IDC-P exclusively and 6 with a mix of IDC-P and invasive carcinoma comedonecrosis foci. These results suggest that comedonecrosis is strongly associated with IDC-P and hence, the routine assignment of pattern 5 to carcinoma exhibiting comedonecrosis should be reconsidered.
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Affiliation(s)
- Samson W. Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Satish K. Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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26
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Trinh VQ, Sirois J, Benzerdjeb N, Mansoori BK, Grosset AA, Albadine R, Latour M, Mes-Masson AM, Hovington H, Bergeron A, Ladouceur M, Fradet Y, Saad F, Trudel D. The impact of intraductal carcinoma of the prostate on the site and timing of recurrence and cancer-specific survival. Prostate 2018; 78:697-706. [PMID: 29603326 DOI: 10.1002/pros.23513] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate the effect of intraductal carcinoma of the prostate (IDC-P) in radical prostatectomy (RP) specimens in the context of the site of recurrence, time to recurrence, and cancer-specific survival in two academic cohorts of locally, regionally, or distantly recurrent prostate cancer. METHODS Our cohort included men enrolled into two academic tissue repositories from 1993 to 2011, who were treated with first-line RP who later experienced local recurrence, regional recurrence, or distant metastasis (together termed clinical recurrence, CR). RP material was reviewed to identify IDC-P and to update grading to current standards. The primary endpoint was the initial location of CR. Secondary endpoints included time to CR and cancer-specific survival. Pearson's chi-square, Welch's t-test, Mann-Whitney U test and Fisher's exact test were performed for univariate analyses. Multinomial logistic regression was used for multivariate analyses. Cancer-specific survival was analyzed with the generalized Wilcoxon test and Cox regression. RESULTS Eighty-five patients with CR were included in the analysis. IDC-P was present in 78.5% of patients from Center 1 and 70.0% from Center 2 (P = 0.547). IDC-P was independently associated with distant metastasis at initial CR (multivariate odds ratio = 6.27, P = 0.015). IDC-P status did not affect time to recurrence; median survival without recurrence was at 53 months for IDC-P(+) and at 50 months for IDC-P(-) (P = 0.441). Distant metastases at the initial CR event had a 36% reduction of cancer-specific survival compared to local recurrences (P = 0.007). Additionally, prostatic-bed radiotherapy (adjuvant or salvage for biochemical recurrence before distant metastasis) was associated with a 25% reduction in cancer-specific mortality compared to no radiotherapy (P = 0.023). Similar reduction in cancer-specific mortality was observed in the subgroup of patients with distant metastasis and IDC-P when treated with radiotherapy (29%, P = 0.050). CONCLUSIONS In our cohort, presence of IDC-P was an independent factor for distant metastasis at initial CR, but did not have a significant impact on time to CR. Furthermore, metastatic patients showed statistically reduced cancer-specific mortality when treated with radiotherapy. This reduction in cancer-specific mortality was also identified in patients with IDC-P. Future large scale validation studies should take into account the presence of IDC-P and confirm its impact on disease progression.
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Affiliation(s)
- Vincent Q Trinh
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
| | - Jennifer Sirois
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Nazim Benzerdjeb
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
| | - Babak K Mansoori
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- CHU de Québec-Université Laval, Québec, Canada
| | - Andrée-Anne Grosset
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
| | - Roula Albadine
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mathieu Latour
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Anne-Marie Mes-Masson
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, Montréal, Canada
| | - Hélène Hovington
- CHU de Québec-Université Laval, Québec, Canada
- Laboratoire d'Uro-Oncologie Expérimentale, Centre de recherche du CHU de Québec-Université Laval, Hôpital L'Hôtel-Dieu de Québec, Québec, Canada
| | - Alain Bergeron
- CHU de Québec-Université Laval, Québec, Canada
- Laboratoire d'Uro-Oncologie Expérimentale, Centre de recherche du CHU de Québec-Université Laval, Hôpital L'Hôtel-Dieu de Québec, Québec, Canada
| | - Martin Ladouceur
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
| | - Yves Fradet
- CHU de Québec-Université Laval, Québec, Canada
- Laboratoire d'Uro-Oncologie Expérimentale, Centre de recherche du CHU de Québec-Université Laval, Hôpital L'Hôtel-Dieu de Québec, Québec, Canada
| | - Fred Saad
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
- Department of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Canada
| | - Dominique Trudel
- Department of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Institut du cancer de Montréal, Montréal, Québec, Canada
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27
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Montironi R, Zhou M, Magi-Galluzzi C, Epstein JI. Features and Prognostic Significance of Intraductal Carcinoma of the Prostate. Eur Urol Oncol 2018; 1:21-28. [DOI: 10.1016/j.euo.2018.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022]
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28
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Shah RB, Yoon J, Liu G, Tian W. Atypical intraductal proliferation and intraductal carcinoma of the prostate on core needle biopsy: a comparative clinicopathological and molecular study with a proposal to expand the morphological spectrum of intraductal carcinoma. Histopathology 2017; 71:693-702. [DOI: 10.1111/his.13273] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Rajal B Shah
- Division of Pathology; Miraca Life Sciences; Irving TX USA
- Department of Pathology; Baylor College of Medicine; Houston TX USA
| | - Jiyoon Yoon
- Division of Pathology; Miraca Life Sciences; Irving TX USA
| | - Gang Liu
- University of Toledo; Toledo OH USA
| | - Wei Tian
- Division of Pathology; Miraca Life Sciences; Irving TX USA
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29
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Olkhov-Mitsel E, Siadat F, Kron K, Liu L, Savio AJ, Trachtenberg J, Fleshner N, van der Kwast T, Bapat B. Distinct DNA methylation alterations are associated with cribriform architecture and intraductal carcinoma in Gleason pattern 4 prostate tumors. Oncol Lett 2017; 14:390-396. [PMID: 28693181 DOI: 10.3892/ol.2017.6140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/23/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of the present study was to explore DNA methylation aberrations in association with cribriform architecture and intraductal carcinoma (IDC) of the prostate, as there is robust evidence that these morphological features are associated with aggressive disease and have significant clinical implications. Herein, the associations of a panel of seven known prognostic DNA methylation biomarkers with cribriform and IDC features were examined in a series of 91 Gleason pattern (GP) 4 tumors derived from Gleason score 7 radical prostatectomies. Gene specific DNA methylation was compared between cribriform and/or IDC positive vs. negative cases, and in association with clinicopathological features, using Chi square and Mann-Whitney U tests. DNA methylation of the adenomatous polyposis coli, Ras association domain family member 1 and T-box 15 genes was significantly elevated in GP4 tumors with cribriform and/or IDC features compared with negative cases (P=0.045, P=0.007 and P=0.013, respectively). To the best of our knowledge, this provides the first evidence for an association between cribriform and/or IDC and methylation biomarkers, and warrants further investigation of additional DNA methylation events in association with various architectural patterns in prostate cancer.
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Affiliation(s)
- Ekaterina Olkhov-Mitsel
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T3L9, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A1, Canada
| | - Farshid Siadat
- Department of Anatomical Pathology, Royal Alexandra Hospital, Edmonton, AB T5H3V9, Canada
| | - Ken Kron
- Ontario Cancer Institute, Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G0A3, Canada
| | - Liyang Liu
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T3L9, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A1, Canada
| | - Andrea J Savio
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T3L9, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A1, Canada
| | - John Trachtenberg
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Theodorus van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A1, Canada.,Department of Pathology, University Health Network, Toronto, ON M5G2C4, Canada
| | - Bharati Bapat
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T3L9, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A1, Canada.,Department of Pathology, University Health Network, Toronto, ON M5G2C4, Canada
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30
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Atypical Intraductal Cribriform Proliferations of the Prostate Exhibit Similar Molecular and Clinicopathologic Characteristics as Intraductal Carcinoma of the Prostate. Am J Surg Pathol 2017; 41:550-556. [DOI: 10.1097/pas.0000000000000794] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Downes MR, Satturwar S, Trudel D, van der Kwast TH. Evaluation of ERG and PTEN protein expression in cribriform architecture prostate carcinomas. Pathol Res Pract 2017; 213:34-38. [DOI: 10.1016/j.prp.2016.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
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32
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Abstract
Intraductal carcinoma of the prostate (IDC-P) is characterized by prostatic carcinoma involving ducts and/or acini. The presence of IDC-P is usually associated with a high-grade Gleason score, large tumor volume, and adverse prognostic parameters, including extraprostatic extension and seminal vesicle invasion. When present, IDC-P is associated with worse outcomes, regardless of treatment status. IDC-P is included in a broader diagnostic category of atypical cribriform lesions of the prostate gland. This category of lesions also includes high-grade prostatic intraepithelial neoplasia (HGPIN), urothelial carcinoma involving prostatic ducts or acini, and prostatic ductal adenocarcinoma, amongst other intraductal proliferations. Differentiating between these entities is important as they have differing therapeutic and prognostic implications for patients, although differential diagnosis thereof is not always straightforward. The present review discusses IDC-P in regards to its morphological characteristics, molecular features, and clinical outcomes. Given the current state of knowledge, the presence of IDC-P should be evaluated and documented correctly in both radical prostatectomy and needle biopsy specimens, and the clinical implications thereof should be taken into consideration during treatment and follow up.
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MESH Headings
- Carcinoma, Acinar Cell/chemistry
- Carcinoma, Acinar Cell/diagnosis
- Carcinoma, Acinar Cell/pathology
- Carcinoma, Ductal/chemistry
- Carcinoma, Ductal/diagnosis
- Carcinoma, Ductal/pathology
- Carcinoma, Transitional Cell/chemistry
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/pathology
- Diagnosis, Differential
- Humans
- Male
- Neoplasm Grading
- Prostatic Intraepithelial Neoplasia/chemistry
- Prostatic Intraepithelial Neoplasia/diagnosis
- Prostatic Intraepithelial Neoplasia/pathology
- Prostatic Neoplasms/chemically induced
- Prostatic Neoplasms/diagnosis
- Prostatic Neoplasms/pathology
- Tumor Burden
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Affiliation(s)
- Mukul K Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA.
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33
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Chen N, Zhou Q. Intraductal carcinoma of prostate (IDC-P): from obscure to significant. Chin J Cancer Res 2016; 28:99-106. [PMID: 27041932 DOI: 10.3978/j.issn.1000-9604.2016.01.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The concept of intraductal carcinoma of prostate (IDC-P) has evolved over the years and its clinicopathologic significance has come to be more clearly appreciated. In contrast to morphologically malignant intraductal lesions that represent earlier stages of the malignant process in other anatomic sites such as the breast, IDC-P has now been generally recognized as a prognostically unfavorable manifestation of later stage spreading of its invasive counterpart. We here briefly review the evolution of the IDC-P concept, the histological diagnostic criteria and differential diagnosis, the clinical significance, as well as recent molecular data of IDC-P.
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Affiliation(s)
- Ni Chen
- Department of Pathology, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
| | - Qiao Zhou
- Department of Pathology, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
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34
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Torabi-Nezhad S, Malekmakan L, Mashayekhi M, Daneshian A. Histopathological features of intra-ductal carcinoma of prostatic and high grade prostatic intraepithelialneoplasia and correlation with PTEN and P63. Prostate 2016; 76:394-401. [PMID: 26643011 DOI: 10.1002/pros.23130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The main morphologic differential diagnosis of intra-ductal carcinoma of prostate (IDC-P) is high grade prostatic intraepithelialneoplasia (HGPIN). Since IDC-P, unlike PIN, was strongly correlated with aggressive prostate cancer, differentiation of these is too necessary. So we evaluated immunohistopathological patterns and the prognostic factors of IDC-P and HGPIN, in radical prostatectomy samples. METHODS We evaluated 250 radical prostatectomy and detected 210 cases of prostatic adenocarcinoma without IDC-P foci, 40 cases with adenocarcinoma concomitant IDC-P, and 40 cases HGPIN; therefore, we evaluated immunohistopathological criteria in these groups. Data were analyzed using SPSS and P-value <0.05 was considered as the statistical significant level. RESULTS PSA level was significantly higher in IDC-P compared with non-IDC-P patients (15.7 ± 3.1 vs. 10.2 ± 4.3, P = 0.041). All pathological and morphologic features, also invasions factors were higher in IDC-P compared to non-IDC-P groups (P < 0.001). P63 was positive expressed in all IDC-P and HGPIN specimen. PTEN protein was diffusely expressed in the cytoplasm of all HGPIN but in 4 (11.1%) of IDC-P. PTEN and P63 were negative in adenocarcinoma foci. CONCLUSION We found that IDC-P had a unique histoclinical feature and was strongly associated with poor prognostic factors. Diagnosis and report of IDC-P should be considered in all prostate specimens. Also, we recommend PTEN IHC application for differentiated IDC-P from HGPIN in biopsies.
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Affiliation(s)
- Simin Torabi-Nezhad
- Department of Pathology, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Malekmakan
- Department of Community Medicine, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohadese Mashayekhi
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arghavan Daneshian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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35
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Varma M, Egevad L, Algaba F, Berney D, Bubendorf L, Camparo P, Comperat E, Erbersdobler A, Griffiths D, Grobholz R, Haitel A, Hulsbergen-van de Kaa C, Langner C, Loftus B, Lopez-Beltran A, Mayer N, Nesi G, Oliveira P, Oxley J, Rioux-Leclercq N, Seitz G, Shanks J, Kristiansen G. Intraductal carcinoma of prostate reporting practice: a survey of expert European uropathologists. J Clin Pathol 2016; 69:852-7. [DOI: 10.1136/jclinpath-2016-203658] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/10/2016] [Indexed: 11/03/2022]
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36
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Korsten H, Ziel-van der Made ACJ, van Weerden WM, van der Kwast T, Trapman J, Van Duijn PW. Characterization of Heterogeneous Prostate Tumors in Targeted Pten Knockout Mice. PLoS One 2016; 11:e0147500. [PMID: 26807730 PMCID: PMC4726760 DOI: 10.1371/journal.pone.0147500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/05/2016] [Indexed: 11/18/2022] Open
Abstract
Previously, we generated a preclinical mouse prostate tumor model based on PSA-Cre driven inactivation of Pten. In this model homogeneous hyperplastic prostates (4-5m) developed at older age (>10m) into tumors. Here, we describe the molecular and histological characterization of the tumors in order to better understand the processes that are associated with prostate tumorigenesis in this targeted mouse Pten knockout model. The morphologies of the tumors that developed were very heterogeneous. Different histopathological growth patterns could be identified, including intraductal carcinoma (IDC), adenocarcinoma and undifferentiated carcinoma, all strongly positive for the epithelial cell marker Cytokeratin (CK), and carcinosarcomas, which were negative for CK. IDC pattern was already detected in prostates of 7-8 month old mice, indicating that it could be a precursor stage. At more than 10 months IDC and carcinosarcoma were most frequently observed. Gene expression profiling discriminated essentially two molecular subtypes, denoted tumor class 1 (TC1) and tumor class 2 (TC2). TC1 tumors were characterized by high expression of epithelial markers like Cytokeratin 8 and E-Cadherin whereas TC2 tumors showed high expression of mesenchyme/stroma markers such as Snail and Fibronectin. These molecular subtypes corresponded with histological growth patterns: where TC1 tumors mainly represented adenocarcinoma/intraductal carcinoma, in TC2 tumors carcinosarcoma was the dominant growth pattern. Further molecular characterization of the prostate tumors revealed an increased expression of genes associated with the inflammatory response. Moreover, functional markers for senescence, proliferation, angiogenesis and apoptosis were higher expressed in tumors compared to hyperplasia. The highest expression of proliferation and angiogenesis markers was detected in TC2 tumors. Our data clearly showed that in the genetically well-defined PSA-Cre;Pten-loxP/loxP prostate tumor model, histopathological, molecular and biological heterogeneity occurred during later stages of tumor development.
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MESH Headings
- Adenocarcinoma/chemistry
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Animals
- Apoptosis/genetics
- Biomarkers
- Biomarkers, Tumor
- Cadherins/analysis
- Carcinoma/chemistry
- Carcinoma/genetics
- Carcinoma/pathology
- Carcinosarcoma/chemistry
- Carcinosarcoma/genetics
- Carcinosarcoma/pathology
- Cellular Senescence/genetics
- Disease Progression
- Epithelial Cells/chemistry
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Inflammation/genetics
- Keratins/analysis
- Male
- Mesoderm/chemistry
- Mice
- Mice, Inbred Strains
- Mice, Knockout
- Neoplasm Proteins/analysis
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/pathology
- PTEN Phosphohydrolase/deficiency
- Prostatic Hyperplasia/genetics
- Prostatic Hyperplasia/pathology
- Prostatic Neoplasms/chemistry
- Prostatic Neoplasms/classification
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/pathology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Neoplasm/biosynthesis
- RNA, Neoplasm/genetics
- Stromal Cells/chemistry
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Affiliation(s)
- Hanneke Korsten
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Wytske M. van Weerden
- Department of Urology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Theo van der Kwast
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Trapman
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Petra W. Van Duijn
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Urology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
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37
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Kristiansen G, Varma M, Seitz G. [Intraductal carcinoma of the prostate]. DER PATHOLOGE 2016; 37:27-32. [PMID: 26782033 DOI: 10.1007/s00292-015-0138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For many tumor entities, especially in breast cancer, an intraductal carcinoma is generally perceived as a precursor lesion, which precedes the emergence of invasive carcinoma. Therefore, in addition to parameters of the invasive carcinoma, histological parameters of the intraductal component have always played an important role in therapy planning of breast cancer. This is different in prostate cancer and although the term "intraductal carcinoma" has long been propagated by some authors, its routine use remains rare and inconsistent. This is certainly not only due to the far simpler therapy options of prostate cancer, in which focal and organ-preserving therapies still play a subordinate role, but also due to substantial interobserver variation and our inconsistent perception of intraductal carcinomas. This article gives a brief overview of currently available literature on this topic and explains why intraductal carcinoma of the prostate deserves our attention. In contrast to breast cancer, intraductal carcinoma of the prostate usually represents a post-invasive lesion, in which an aggressive tumor exhibits spread into pre-existing ducts; however, in rare cases, intraductal carcinoma may represent a true precursor lesion.
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Affiliation(s)
- G Kristiansen
- Institut für Pathologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, Gebäude 329, 53127, Bonn, Deutschland.
| | - M Varma
- Department of Histopathology, University Hospital of Wales, Cardiff, UK
| | - G Seitz
- Gemeinschaftspraxis für Pathologie am Klinikum Bamberg, Bamberg, Deutschland
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38
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Magers M, Kunju LP, Wu A. Intraductal Carcinoma of the Prostate: Morphologic Features, Differential Diagnoses, Significance, and Reporting Practices. Arch Pathol Lab Med 2015; 139:1234-41. [DOI: 10.5858/arpa.2015-0206-ra] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The differential diagnosis for atypical cribriform lesions of the prostate has become increasingly complex and includes intraductal carcinoma of the prostate, high-grade prostatic intraepithelial neoplasia, and atypical intraductal proliferations. In this review, we summarize the morphologic and molecular features and significance of intraductal carcinoma of the prostate. We also summarize our institution's strategy for reporting and treatment recommendations for intraductal carcinoma of the prostate.
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Affiliation(s)
- Martin Magers
- From the Department of Pathology, University of Michigan Hospitals, Ann Arbor
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39
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Chen Z, Chen N, Shen P, Gong J, Li X, Zhao T, Liao B, Liu L, Liu Z, Zhang X, Liu J, Peng Z, Chen X, Xu M, Gui H, Zhang P, Wei Q, Zhou Q, Zeng H. The presence and clinical implication of intraductal carcinoma of prostate in metastatic castration resistant prostate cancer. Prostate 2015; 75:1247-54. [PMID: 25917338 DOI: 10.1002/pros.23005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/26/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intraductal carcinoma of prostate (IDC-P) is always underestimated pathological pattern in prostate cancer and its role is still unclear in castration resistant prostate cancer (CRPC). This study was conducted to investigate the presence and the roles of IDC-P in patients with metastatic CRPC. METHODS 45 patients with initially diagnosed metastatic prostate cancer and then progressed to CRPC, were included. All of them were received twice transperineal biopsies at the time of initial diagnosis and the time of CRPC. All samples were retrieved to detect the presence of IDC-P. PSA doubling time (PSADT) was considered as a parameter presenting the progression of CRPC. The relationships between IDC-P and other clinicopathological variables were analyzed. RESULTS IDC-P was found only in 20% (9/45) cases at initial diagnosis, whereas, it increased to 62.5% (28/45) at the time of CRPC (χ(2) = 16.568, P = 0.000). Compared to acinar adenocarcinoma components in tumor tissues, IDC-P components, especially solid subtype, had obviously poor/no response to androgen deprivation therapy (ADT). In addition, among patients treated with docetaxel-based chemotherapy (n = 24), patients with IDC-P also showed more unfavorable response than those without IDC-P (20% vs. 66.7%, P = 0.022). The presence of IDC-P and serum testosterone at the time of CRPC, were significantly associated with rapid disease progression. 13/28 (46.4%) CRPC with IDC-P had PSADT less than 30 days, while, only 1/17 (5.9%) patient without IDC-P had a less than 30 days PSADT (χ(2) = 8.114, P = 0.004). Limitations included the relative short follow-up time and a relative small cohort. CONCLUSIONS The presence of IDC-P was significantly associated with rapid progression of CRPC. And its presence could suggest the poor response to initial ADT and sequential docetaxel-based chemotherapy. Detection of IDC-P should be of importance in CRPC, and re-biopsy at the time of CRPC might be one of practical solutions. The mechanism of the ADT and docetaxel resistance to IDC-P needed to be further investigated.
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Affiliation(s)
- Zhibin Chen
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Urology, The First people's Hospital of Neijiang, Sichuan, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengfei Shen
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Gong
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Li
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhao
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Banghua Liao
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liangren Liu
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenhua Liu
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingming Zhang
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiyan Liu
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhufeng Peng
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueqin Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Xu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Haojun Gui
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Zhang
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wei
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiao Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zeng
- Departmentof Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Zhao T, Liao B, Yao J, Liu J, Huang R, Shen P, Peng Z, Gui H, Chen X, Zhang P, Zhu Y, Li X, Wei Q, Zhou Q, Zeng H, Chen N. Is there any prognostic impact of intraductal carcinoma of prostate in initial diagnosed aggressively metastatic prostate cancer? Prostate 2015; 75:225-32. [PMID: 25307858 DOI: 10.1002/pros.22906] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/26/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intraductal carcinoma of prostate (IDC-P) was usually found to be co-exist with conventional aggressive prostate adenocarcinoma. The presence of IDC-P was considered as an adverse pathological factor, which was associated with high Gleason score, large prostate volume and accelerated disease progression. However, no any information is available on the presence of IDC-P diagnosed by needle biopsy in patients with metastatic prostate cancer. We investigated the incidence and prognostic value of intraductal carcinoma of prostate (IDC-P) in initial diagnosed metastatic prostate cancer. METHODS We included 278 patients with initial diagnosed metastatic prostate cancer treated between 2008 and 2011, all the pathological diagnosis were from ultrasonic-guided transperineal needle biopsy. IDC-P was strictly defined according to Epstein's criteria. Analyzed factors included age, Eastern Cooperative Oncology Group (ECOG) score, clinical T staging, Gleason scores, baseline prostate specific antigen (PSA), alkaline phosphatase (ALP), hemoglobin (HGB), PSA normalization, and the presence of IDC-P. RESULTS Totally, IDC-P was found in 57/278 (20.5%) cases. Univariate analysis showed that, compared with cases without IDC-P, cases with IDC-P was definitely associated with much shorter CRPC-free survival (CFS) time (46.05 ± 1.39 vs. 22.98 ± 1.80 months, P = 0.000) and OS time (50.38 ± 1.18 vs. 36.43 ± 2.10 months, P = 0.000). Multivariate analysis showed that the presence of IDC-P was the only independent prognostic factor associated with poor CFS (HR = 4.886, P = 0.011) and OS (HR = 1.945, P = 0.020). Further sub-analysis showed, even among patients with higher Gleason score (≥8) (n = 158), IDC-P was still significantly and inversely associated with CFS and OS (the median CFS time: 40 versus 22 months; P = 0.000; the median OS time: 54 vs. 36 months, P = 0.000). Again, Cox's regression model confirmed that only the presence of IDC-P was still not only an independent prognostic factor predicting shorter time of CRPC (HR = 4.031, P = 0.035), but also for poorer OS (HR = 2.499, P = 0.006). CONCLUSIONS The presence of IDC-P in initial diagnosed metastatic prostate cancer, even among patients with more aggressive pattern, was firstly found to be significantly and independently associated with earlier occurrence of CRPC and poorer OS. We recommended the presence of IDC-P should be a routine record in pathological report of clinical diagnosis and other potential therapeutic regimen might be added to intervene in the integrated therapy as early as possible. Prostate 75:225-232, 2015. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Tao Zhao
- Department of Urology, West China Hospital, SiChuan University, Chengdu, P.R. China
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Iczkowski KA, Egevad L, Ma J, Harding-Jackson N, Algaba F, Billis A, Camparo P, Cheng L, Clouston D, Comperat EM, Datta MW, Evans AG, Griffiths DF, Guo CC, Hailemariam S, Huang W, Humphrey PA, Jiang Z, Kahane H, Kristiansen G, La Rosa FG, Lopez-Beltran A, MacLennan GT, Magi-Galluzzi C, Merrimen J, Montironi R, Osunkoya AO, Picken MM, Rao N, Shah RB, Shanks JH, Shen SS, Tawfik OW, True LD, Van der Kwast T, Varma M, Wheeler TM, Zynger DL, Sahr N, Bostwick DG. Intraductal carcinoma of the prostate: interobserver reproducibility survey of 39 urologic pathologists. Ann Diagn Pathol 2014; 18:333-42. [DOI: 10.1016/j.anndiagpath.2014.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
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Tsuzuki T. Intraductal carcinoma of the prostate: a comprehensive and updated review. Int J Urol 2014; 22:140-5. [PMID: 25358604 DOI: 10.1111/iju.12657] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/18/2014] [Indexed: 11/27/2022]
Abstract
Intraductal carcinoma of the prostate is characterized by prostatic carcinoma cells growing within ducts and/or acini. These tumors are usually associated with a high-grade Gleason score, large tumor volume and advanced stage. Intraductal carcinoma of the prostate is also a well-known adverse independent prognostic factor regardless of treatment. Recent studies have shown that intraductal carcinoma of the prostate is a distinctive disease entity that is different from invasive prostate carcinoma, which is generally invasive. Although the Gleason score does not consider intraductal carcinoma of the prostate, some cribriform prostate carcinomas graded as pattern 4 could be considered as intraductal carcinomas. The definition of intraductal carcinoma of the prostate is not unified, because it can occur with or without invasive prostate carcinoma. Furthermore, diagnosis of intraductal carcinoma of the prostate without invasive prostate carcinoma by needle biopsy is crucial, but is a rare event. Differential diagnosis of intraductal carcinoma of the prostate includes several pathologies. This is especially true for high-grade prostatic intraepithelial neoplasia, although its distinction is not always straightforward. The present review discusses the concept of intraductal carcinoma of the prostate, and also describes its morphological characteristics, molecular features and clinical outcome. Given the current state of knowledge, the presence of intraductal carcinoma of the prostate should be evaluated and documented correctly in both radical prostatectomy and needle biopsy, and the clinical implications should be taken into consideration during treatment and follow up.
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Affiliation(s)
- Toyonori Tsuzuki
- Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
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43
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Kan RWM, Kan CF, Wong JHM, Fu KKF, Ng CF, Chan SWH. Ductal adenocarcinoma of the prostate: a Hong Kong case series. Int Urol Nephrol 2014; 46:2133-7. [PMID: 25080209 DOI: 10.1007/s11255-014-0793-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To review and report our local experience in the management of ductal adenocarcinoma of the prostate. METHODS Retrospective review of patients diagnosed with ductal adenocarcinoma of the prostate in two regional urological centres in Hong Kong during 1995-2009. Clinical information, treatment and outcomes were retrieved for further analysis. RESULTS We identified 19 Chinese patients diagnosed with ductal adenocarcinoma of the prostate. Majority of our patients presented with retention of urine and haematuria. At presentation, seven patients were already at an advanced stage with evidence of rectal invasion or distant metastasis. The overall treatment outcome was poor with high failure rate after either local or systemic hormonal therapy. CONCLUSION We observed a predilection of this tumour to be locally aggressive, and hence a relatively high incidence of intra-luminal growth and rectal invasion. We observed a high failure rate after either radical prostatectomy or hormonal therapy.
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Kimura K, Tsuzuki T, Kato M, Saito AM, Sassa N, Ishida R, Hirabayashi H, Yoshino Y, Hattori R, Gotoh M. Prognostic value of intraductal carcinoma of the prostate in radical prostatectomy specimens. Prostate 2014; 74:680-7. [PMID: 24481730 DOI: 10.1002/pros.22786] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/06/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intraductal carcinoma of the prostate (IDC-P) is an adverse prognostic factor for radical prostatectomy (RP). The endpoint in most IDC-P studies is increased prostate-specific antigen (PSA) levels. The aim of this study was to evaluate whether IDC-P in RP specimens is an adverse prognostic factor for progression-free survival (PFS) and cancer-specific survival (CSS). METHODS We retrospectively evaluated 206 high-risk prostate cancer patients treated with RP and analyzed data on age, serum PSA level at diagnosis, biopsy Gleason score (bGS), surgical margin (SM), clinical T stage (cT), extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node metastasis (LN), and neoadjuvant therapy. RESULTS An IDC-P component was found in 104 cases. Forty-four patients experienced clinical failure, and 20 patients died of the disease. Patients with IDC-P showed a higher bGS and stage (including cT, EPE, SVI, and LN) than those without IDC-P. In univariate analysis, IDC-P, PSA level, bGS, SM, cT, SVI, LN, and EPE (P < 0.0001) were significantly associated with PFS. IDC-P (P = 0.0004), PSA level (P < 0.0001), SM (P = 0.0013), cT (P = 0.0019), SVI (P = 0.0012), and LN (P = 0.0002) were significantly associated with CSS. In multivariate analysis, IDC-P (P = 0.0038), and cT (P = 0.0001) were significantly associated with PFS. IDC-P (P = 0.0238) and PSA level (P = 0.0112) were significantly associated with CSS. CONCLUSIONS IDC-P in RP specimens was an independent risk factor for PFS and CSS and could predict clinical outcomes.
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Affiliation(s)
- Kyosuke Kimura
- Department of Urology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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45
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Abstract
Intraductal carcinoma of the prostate (IDC-P) is characterised by proliferation of malignant secretory cells that markedly expand prostatic ducts and acini. Its morphological features and diagnostic criteria have been refined in recent studies. Its molecular characteristics have also been increasingly elucidated. IDC-P is strongly associated with high grade and high volume invasive prostate cancer and unfavourable clinical outcomes. Therefore, it is critical to recognise and report IDC-P, especially in prostate biopsies where the clinical implications of the diagnosis are greatest. IDC-P has to be distinguished from several other prostate lesions with similar histological appearance. The distinction between IDC-P and high grade prostatic intraepithelial neoplasia is most important as they have drastically different implications for patient management. IDC-P is an uncommon finding in prostate biopsies, and is even rarer as an isolated finding without concomitant prostate cancer in biopsies. However, patients with isolated IDC-P in biopsies are recommended for either definitive treatment or immediate repeat biopsy. This article will review the historical aspect, diagnostic criteria, molecular genetics, and clinical significance of IDC-P.
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Trudel D, Downes MR, Sykes J, Kron KJ, Trachtenberg J, van der Kwast TH. Prognostic impact of intraductal carcinoma and large cribriform carcinoma architecture after prostatectomy in a contemporary cohort. Eur J Cancer 2014; 50:1610-6. [PMID: 24703897 DOI: 10.1016/j.ejca.2014.03.009] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intraductal carcinoma (IDC) of prostate is a distinct entity associated with higher Gleason score and poor prognosis. The prognostic significance of large cribriform Gleason pattern 4 (LC) in conjunction with IDC has not been previously investigated. The aim of our study was to determine the impact of IDC and LC on biochemical recurrence-free rate (bRFR) in a contemporary prostatectomy cohort. METHODS Prostate cancers of 246 prostatectomies, median follow-up 130.6 months, were graded with the International Society of Urological Pathology (ISUP) 2005 modified Gleason score (GS) and assessed for the presence of LC and/or IDC. In 57 cases with LC and/or IDC, immunostaining was performed to distinguish LC and IDC. The Kaplan-Meier (KM) method was used to estimate 5-year bRFR probabilities. Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Multivariable analysis showed that the presence of any amount of LC or IDC had a highly significant prognostic effect on bRFR (HR 2.98, 95% CI: 1.68-5.28, p=0.0002) after adjusting for GS, surgical margin status and pathological stage. Although IDC alone tended to be associated with a worse prognosis, LC and IDC did not appear to be associated with a difference in bRFR when analysed separately. CONCLUSION We demonstrate that the presence of any amount of LC/IDC is a significant prognostic factor after adjusting for Gleason score and T stage in determining patient outcome and we advocate including the presence of either in routine pathology reporting.
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Affiliation(s)
- Dominique Trudel
- Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - Michelle R Downes
- Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - Jenna Sykes
- Dept. of Biostatistics, Princess Margaret Cancer Center, University Health Network, 610 University Avenue, Toronto, ON M5T 2M9, Canada
| | - Ken J Kron
- Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - John Trachtenberg
- Dept. of Urology, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| | - Theodorus H van der Kwast
- Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
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Roberts JA, Zhou M, Park YW, Park YW, Ro JY. Intraductal carcinoma of prostate: a comprehensive and concise review. KOREAN JOURNAL OF PATHOLOGY 2013; 47:307-15. [PMID: 24009625 PMCID: PMC3759629 DOI: 10.4132/koreanjpathol.2013.47.4.307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 12/13/2022]
Abstract
Intraductal carcinoma of the prostate (IDC-P) is defined as a proliferation of prostate adenocarcinoma cells distending and spanning the lumen of pre-existing benign prostatic ducts and acini, with at least focal preservation of basal cells. Studies demonstrate that IDC-P is strongly associated with high-grade (Gleason grades 4/5), large-volume invasive prostate cancers. In addition, recent genetic studies indicate that IDC-P represents intraductal spread of invasive carcinoma, rather than a precursor lesion. Some of the architectural patterns in IDC-P exhibit architectural overlap with one of the main differential diagnoses, high-grade prostatic intraepithelial neoplasia (HGPIN). In these instances, additional diagnostic criteria for IDC-P, including marked nuclear pleomorphism, non-focal comedonecrosis (>1 duct showing comedonecrosis), markedly distended normal ducts/acini, positive nuclear staining for ERG, and cytoplasmic loss of PTEN by immunohistochemistry, can help make the distinction. This distinction between IDC-P and HGPIN is of critical importance because IDC-P has an almost constant association with invasive carcinoma and has negative clinical implications, including shorter relapse-free survival, early biochemical relapse, and metastatic failure rate after radiotherapy. Therefore, IDC-P should be reported in prostate biopsies and radical prostatectomies, regardless of the presence of an invasive component. This article will review the history, diagnostic criteria, molecular genetics, and clinical significance of IDC-P.
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Affiliation(s)
- Jordan A Roberts
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
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Watts K, Li J, Magi-Galluzzi C, Zhou M. Incidence and clinicopathological characteristics of intraductal carcinoma detected in prostate biopsies: a prospective cohort study. Histopathology 2013; 63:574-9. [PMID: 23931616 DOI: 10.1111/his.12198] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022]
Abstract
AIMS Intraductal carcinoma of the prostate (IDC-P) is a distinct clinicopathological entity and is associated with aggressive, high-grade and high-volume prostate carcinoma (PCa). The incidence, clinicopathological characteristics and prognostic significance of IDC-P have not been reported in prostate biopsies (PBx) that surgical pathologists encounter in their daily practice. METHODS AND RESULTS In 1176 prospectively collected PBx, 33 IDC-P cases were identified (2.8%). The mean age of patients with IDC-P was 65 (range 46-79) years and mean serum prostate-specific antigen was 16.2 (range 0.4-105.6) ng/ml. Three (0.26%) IDC-P cases did not have a concomitant invasive PCa. Of 30 cases with concomitant invasive PCa, Gleason score was 7 in 16 (53.3%), 8 in four (13.3%) and 9 in 10 (33.3%) cases. The mean number of biopsy cores involved by PCa was 7.2 (range 1-14). Nine patients were treated with radical prostatectomy. Seminal vesicle invasion was found in four of nine (44%) cases, significantly higher than the risk of 12% predicted by Partin Tables (P = 0.016). CONCLUSIONS This is the first prospective study that has investigated the incidence and prognostic significance of IDC-P diagnosed in PBx encountered in daily practice. It is critical for surgical pathologists to diagnose and report IDC-P in PBx.
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Affiliation(s)
- Katherine Watts
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland, OH, USA
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Lotan TL, Gumuskaya B, Rahimi H, Hicks JL, Iwata T, Robinson BD, Epstein JI, De Marzo AM. Cytoplasmic PTEN protein loss distinguishes intraductal carcinoma of the prostate from high-grade prostatic intraepithelial neoplasia. Mod Pathol 2013; 26:587-603. [PMID: 23222491 PMCID: PMC3610824 DOI: 10.1038/modpathol.2012.201] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intraductal carcinoma of the prostate is a marker of aggressive disease. However, intraductal carcinoma exists on a morphologic continuum with high-grade prostatic intraepithelial neoplasia (PIN) and distinguishing intraductal carcinoma from PIN is a common diagnostic dilemma with significant clinical implications. We evaluated whether immunostains for PTEN and ERG can sensitively identify intraductal carcinoma and accurately distinguish it from high-grade PIN. A combined immunostain for PTEN, ERG, p63 and CK903 was developed and validated. Radical prostatectomy specimens with lesions meeting criteria for intraductal carcinoma (n=45), intraductal cribriform proliferations falling short of intraductal carcinoma (n=15), and PIN lesions (n=39) were retrospectively identified and assessed for PTEN and ERG. Cytoplasmic PTEN loss was identified in 84% (38/45) of the intraductal carcinoma and 100% (15/15) of intraductal cribriform proliferation cases. In contrast, cytoplasmic PTEN loss was never observed in PIN (0/39; P<0.0001). Of the 53 cases of intraductal carcinoma or intraductal cribriform proliferation with cytoplasmic PTEN loss, it was homogeneously lost in 42 cases (79%). Weak, focal nuclear positivity for PTEN was retained in 31 of these 42 cases (74%). ERG expression was identified in 58% (26/45) of intraductal carcinoma and 67% (10/15) of intraductal cribriform proliferations compared with 13% (5/39) of PIN. Concordance between the PTEN/ERG status of the intraductal carcinoma lesions and the concurrent invasive carcinoma was high (>95% and P<0.0001 for each), and substantially less for PIN and the concurrent invasive tumor (83% for PTEN and 67% for ERG; P=NS for each). Cytoplasmic PTEN loss occurs in the majority of intraductal carcinoma and intraductal cribriform proliferation cases. Cytoplasmic PTEN loss was never observed in PIN (100% specificity). Our study identifies PTEN loss as a potentially useful marker to distinguish intraductal carcinoma from PIN and provides a plausible molecular explanation for why intraductal carcinoma is associated with poor prognosis.
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Affiliation(s)
- Tamara L Lotan
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
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