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Mullane P, Williamson SR, Sangoi AR. Topline/Final Diagnostic Inclusion of Relevant Histologic Findings in Surgical Pathology Reporting of Carcinoma in Prostate Biopsies. Int J Surg Pathol 2024:10668969241231972. [PMID: 38504649 DOI: 10.1177/10668969241231972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
INTRODUCTION As the list of histologic parameters to include in surgical pathology reports of prostate cancer biopsies grows, some pathologists include this information in the microscopic description or summary sections of the report, whereas others include it in the "topline" or final diagnosis section. This prompted us to develop a multi-institutional survey to assess reporting trends among genitourinary (GU) pathologists. METHODS A survey instrument was shared among 110 GU pathologists via surveymonkey.com. Anonymized respondent data was analyzed. RESULTS Eighty-four (76%) participants completed the survey across four continents. Most participants report tumor volume quantitation (88%), number of cores involved (89%), and both Gleason grade and Grade group (93%) in their topline; 71% include percent of pattern 4, with another 16% including it depending on cancer grade; 58% include the presence of cribriform growth pattern 4, with another 11% including it depending on cancer grade. When present, most include extraprostatic extension (90%), prostatic intraductal carcinoma (77%), and perineural invasion (77%). Inclusion of atypical intraductal proliferation (AIP) in the topline diagnosis was cancer grade-dependent, with 74% including AIP in Grade group 1, 61% in Grade group 2, 45% in Grade group 3, 30% in Grade group 4, and 26% in Grade group 5 cancers. CONCLUSION Certain histologic features such as Gleason grade and tumor volume/cores involved are frequently included in the topline diagnosis, whereas the incorporation of other findings are more variably included. Prostate biopsy reporting remains a dynamic process with stylistic similarities and differences existing among GU pathologists.
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Affiliation(s)
- Patrick Mullane
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
| | | | - Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
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Chuang HW, Wu S, Lin SX, Zhao T, Kim MM, Harisinghani M, Feldman AS, Dahl DM, Wu CL. Detection of extraprostatic extension by transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted combined with systemic template prostate biopsy. Diagn Pathol 2023; 18:101. [PMID: 37697349 PMCID: PMC10494402 DOI: 10.1186/s13000-023-01386-w] [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: 02/12/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Extraprostatic extension (EPE) of prostate cancer (PCa) on transrectal (TR) needle core biopsy (Bx) is a rare histopathological finding that can help in clinical decision-making. The detection efficiency of the transperineal (TP) approach is yet to be explored. METHODS We retrospectively reviewed 2848 PCa cases using concomitant systemic template biopsy (SBx) and multiparametric magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy (TBx) using the TR (n = 1917) or TP (n = 931) approach at our institution between January 2015 and July 2022. We assessed and compared clinical, MRI, and biopsy characteristics using different approaches (TP and TR) and methods (SBx and TBx). RESULTS In total, 40 EPE cases were identified (40/2848, 1.4%). TP showed a significantly higher EPE detection rate compared to TR in SBx (TR:0.7% vs. TP:1.6%; p = 0.028) and TBx (TR:0.5% vs. TP:1.2%; p = 0.033), as well as the combined methods (2.1% vs. 1.1%, p = 0.019). A significantly higher incidence of EPEs was found at non-base sites in TP than in TR (76.7% vs. 50%, p = 0.038). SBx showed a higher EPE detection rate than TBx; however, the difference was not statistically significant. TP showed higher prostate-specific antigen density (0.35 vs. 0.17, p = 0.005), higher frequency of GG4-5 in the cores with EPE (65.0% vs. 50.0%, p = 0.020), and more PCa-positive SBx cores (10 vs. 8, p = 0.023) compared to the TR. CONCLUSIONS TP may improve EPE detection compared with TR and should be applied to patients with adverse pre-biopsy features.
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Affiliation(s)
- Hao-Wen Chuang
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TW, Taiwan
- Institute of Oral Biology, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, TW, Taiwan
| | - Shulin Wu
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ting Zhao
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle M Kim
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mukesh Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Zhao J, Epstein J. Significance of extraprostatic extension by Grade Groups 1-3 prostatic carcinoma on needle biopsy. Prostate 2023; 83:809-813. [PMID: 36946608 DOI: 10.1002/pros.24520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND It is rare for extraprostatic extension (EPE) on biopsy to be seen with Grade Groups (GG) 1-3 (Gleason scores 3 + 3 = 6; 3 + 4 = 7; 4 + 3 = 7) prostatic adenocarcinoma, and there is no data whether this finding should be a contraindication for performing radical prostatectomy (RP). METHODS Thirty eight cases with GG 1-3 prostatic adenocarcinoma as the highest grade in the case with EPE on biopsy were identified from our consultation files. Highly unfavorable findings at RP were those that if they could have been predicted preoperatively, might have factored into the decision of whether to proceed with surgery. For these purposes, highly unfavorable pathology at RP was defined as either the presence of seminal vesicle invasion or lymph node metastases or GG5 (Gleason score 9-10). RESULTS Among 37 patients with clinical follow-up data, 18 (49%) received radiation and/or hormonal therapy (RT/HT), 13 patients (35%) either underwent (n = 11) or are planning (n = 2) RP, and 6 patients (16%) received either ablation therapy or active surveillance. Based on the 11 RP pathology reports, 8 were GG2, one GG3 with tertiary pattern 5, and two GG3. Ten cases were reported to have EPE and six cases had positive margins. Only one had highly unfavorable pathology with pT3bN1 disease. The only difference between the RP and the RT/HT groups in their pretreatment parameters was the mean age of the RP patients was 61 compared with 69 for the RT/HT men (p = 0.02); the lack of many cases with highly unfavorable pathology at RP cannot be attributable to a selection bias of men with lower volume cancer on biopsy or lower serum prostate-specific antigen levels choosing RP over RT/HT. CONCLUSIONS Despite EPE on biopsy, most men do not have highly unfavorable pathology at RP, and this treatment should remain an option in this setting.
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Affiliation(s)
- Jianping Zhao
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jonathan Epstein
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
- Departments of Urology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
- Departments of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Suresh N, Teramoto Y, Goto T, Wang Y, Miyamoto H. Clinical significance of perineural invasion by prostate cancer on MRI-targeted biopsy. Hum Pathol 2022; 121:65-72. [DOI: 10.1016/j.humpath.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
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Chen JR, Zhao JG, Zhu S, Zhang MN, Chen N, Liu JD, Sun GX, Shen PF, Zeng H. Clinical and oncologic findings of extraprostatic extension on needle biopsy in de novo metastatic prostate cancer. Asian J Androl 2021; 22:427-431. [PMID: 31424026 PMCID: PMC7406091 DOI: 10.4103/aja.aja_77_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study aimed to explore the clinical and oncologic findings in patients with de novo metastatic prostate cancer (mPCa) and extraprostatic extension (EPE) on biopsy. We retrospectively evaluated data on 630 patients with de novo mPCa between January 2009 and December 2017 in the West China Hospital (Chengdu, China), including evaluating the relationships between EPE and other variables and the association of EPE with survival outcomes by the Chi-square test, Kaplan-Meier curves, and the Cox proportional-hazards model. EPE was found in 70/630 patients, making a prevalence of 11.1%. The presence of EPE on biopsy was associated with higher Gleason scores and higher incidence of neuroendocrine differentiation (NED), intraductal carcinoma of the prostate (IDC-P), and perineural invasion (PNI). Compared with those without EPE, patients with EPE had shorter castration-resistant prostate cancer-free survival (CFS; median: 14.1 vs 17.1 months, P = 0.015) and overall survival (OS; median: 43.7 vs 68.3 months, P = 0.032). According to multivariate analysis, EPE was not an independent predictor for survival. Subgroup analyses demonstrated that patients with favorable characteristics, including negative NED or IDC-P status, Eastern Cooperative Oncology Group (ECOG) score <2, and prostate-specific antigen (PSA) <50 ng ml-1, had worse prognoses if EPE was detected. In patients with PSA <50 ng ml-1, EPE was a negative independent predictor for OS (hazard ratio [HR]: 4.239, 95% confidence interval [CI]: 1.218-14.756, P = 0.023). EPE was strongly associated with other aggressive clinicopathological features and poorer CFS and OS. These data suggest that EPE may be an indicator of poor prognosis, particularly in patients, otherwise considered likely to have favorable survival outcomes.
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Affiliation(s)
- Jun-Ru Chen
- 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
| | - Sha Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Meng-Ni Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian-Dong 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
| | - 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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Çelik S, Kızılay F, Yörükoğlu K, Aslan G, Ozen H, Akdogan B, Sozen S, Baltaci S, Muezzinoglu T, Izol V, Bayazıt Y, Narter F, Türkeri L. Sextant Biopsy-Based Criteria for Clinically Insignificant Prostate Cancer Are Also Valid for the 12-Core Prostate Biopsy Scheme: A Multicenter Study of Urooncology Association, Turkey. Urol Int 2021; 106:35-43. [PMID: 33951662 DOI: 10.1159/000513658] [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: 09/12/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view. OBJECTIVES To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa. METHOD Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created. RESULTS A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be ≤50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041). CONCLUSIONS Using a cutoff value of "1" for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme.
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Affiliation(s)
- Serdar Çelik
- Department of Basic Oncology, Izmir Bozyaka Training and Research Hospital, Institute of Oncology, Health Science University, Urology Clinic and Dokuz Eylul University, Izmir, Turkey
| | - Fuat Kızılay
- Department of Urology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Kutsal Yörükoğlu
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Güven Aslan
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Haluk Ozen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sinan Sozen
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sumer Baltaci
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Talha Muezzinoglu
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Volkan Izol
- Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yıldırım Bayazıt
- Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fehmi Narter
- Department of Urology, Kadikoy Hospital, Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, Altunizade Hospital, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
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Cohesive cancer invasion of the biophysical barrier of smooth muscle. Cancer Metastasis Rev 2021; 40:205-219. [PMID: 33398621 DOI: 10.1007/s10555-020-09950-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023]
Abstract
Smooth muscle is found around organs in the digestive, respiratory, and reproductive tracts. Cancers arising in the bladder, prostate, stomach, colon, and other sites progress from low-risk disease to high-risk, lethal metastatic disease characterized by tumor invasion into, within, and through the biophysical barrier of smooth muscle. We consider here the unique biophysical properties of smooth muscle and how cohesive clusters of tumor use mechanosensing cell-cell and cell-ECM (extracellular matrix) adhesion receptors to move through a structured muscle and withstand the biophysical forces to reach distant sites. Understanding integrated mechanosensing features within tumor cluster and smooth muscle and potential triggers within adjacent adipose tissue, such as the unique damage-associated molecular pattern protein (DAMP), eNAMPT (extracellular nicotinamide phosphoribosyltransferase), or visfatin, offers an opportunity to prevent the first steps of invasion and metastasis through the structured muscle.
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Goldberg H, Ramiz AH, Glicksman R, Salgado NS, Chandrasekar T, Klaassen Z, Wallis CJ, Hosni A, Moraes FY, Ghai S, Kulkarni GS, Hamilton RJ, Perlis N, Toi A, Chung P, Evans A, van der Kwast T, Finelli A, Fleshner N, Berlin A. Extraprostatic Extension in Core Biopsies Epitomizes High-risk but Locally Treatable Prostate Cancer. Eur Urol Oncol 2019; 2:88-96. [DOI: 10.1016/j.euo.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 01/22/2023]
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Extraprostatic extension (pT3a) in prostate biopsy is an under-recognized feature indicating high risk disease. Ann Diagn Pathol 2018; 35:80-84. [PMID: 29886397 DOI: 10.1016/j.anndiagpath.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/10/2018] [Accepted: 06/03/2018] [Indexed: 11/20/2022]
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Celik S, Bozkurt O, Demir O, Gurboga O, Tuna B, Yorukoglu K, Aslan G. Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy. Kaohsiung J Med Sci 2018; 34:385-390. [PMID: 30063011 DOI: 10.1016/j.kjms.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/14/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022] Open
Abstract
To predict local invasive disease before retropubic radical prostatectomy (RRP), the correlation of perineural invasion (PNI) on prostate needle biopsy (PNB) and RRP pathology data and the effect of PNI on biochemical recurrence (BR) were researched. For patients with RRP performed between 2005 and 2014, predictive and pathologic prognostic factors were assessed. Initially all and D'Amico intermediate-risk group patients were comparatively assessed in terms of being T2 or T3 stage on RRP pathology, positive or negative for PNI presence on PNB and positive or negative BR situation. Additionally the effect of PNI presence on recurrence-free survival (RFS) rate was investigated. When all patients are investigated, multivariate analysis observed that in T3 patients PSA, PNB Gleason score (GS) and tumor percentage were significantly higher; in PNI positive patients PNB GS, core number and tumor percentage were significantly higher and in BR positive patients PNB PNI positivity and core number were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). When D'Amico intermediate-risk patients are evaluated, for T3 patients PSA and PNB tumor percentage; for PNI positive patients PNB core number and tumor percentage; and for BR positive patients PNB PNI positivity were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). Mean RFS in the whole patient group was 56.4 ± 4.2 months for PNI positive and 96.1 ± 5.7 months for negative groups. In the intermediate-risk group, mean RFS was 53.7 ± 5.1 months for PNI positive and 100.3 ± 7.7 months for negative groups (p < 0.001). PNI positivity on PNB was shown to be an important predictive factor for increased T3 disease and BR rates and reduced RFS.
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Affiliation(s)
- Serdar Celik
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Ozan Bozkurt
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Omer Demir
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozgur Gurboga
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Burcin Tuna
- Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Kutsal Yorukoglu
- Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Guven Aslan
- Department of Urology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Grignon DJ. Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens. Mod Pathol 2018; 31:S96-109. [PMID: 29297497 DOI: 10.1038/modpathol.2017.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/10/2017] [Accepted: 10/14/2017] [Indexed: 12/19/2022]
Abstract
Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in the absence of a palpable abnormality. Treatment choices ranging from surveillance to radical prostatectomy or radiation therapy are largely driven by the pathologic findings in the biopsy specimen. The first part of this review focuses on important morphologic parameters in needle biopsy specimens that are not covered in the accompanying articles. This includes tumor quantification as well as other parameters such a extraprostatic extension, seminal vesicle invasion, perineural invasion, and lymphovascular invasion. For those men who undergo radical prostatectomy, pathologic stage and other parameters are critical in prognostication and in determining the appropriateness of adjuvant therapy. Staging parameters, including extraprostatic extension, seminal vesicle invasion, and lymph node status are discussed here. Surgical margin status is also an important parameter and definitions and reporting of this feature are detailed. Throughout the article the current reporting guidelines published by the College of American Pathologists and the International Collaboration on Cancer Reporting are highlighted.
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Affiliation(s)
- David J Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IUH Pathology Laboratory, Indianapolis, IN, USA
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12
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Egevad L, Delahunt B, Kristiansen G, Samaratunga H, Varma M. Contemporary prognostic indicators for prostate cancer incorporating International Society of Urological Pathology recommendations. Pathology 2018; 50:60-73. [DOI: 10.1016/j.pathol.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022]
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Fleshner K, Assel M, Benfante N, Lee J, Vickers A, Fine S, Carlsson S, Eastham J. Clinical Findings and Treatment Outcomes in Patients with Extraprostatic Extension Identified on Prostate Biopsy. J Urol 2016; 196:703-8. [PMID: 27049874 DOI: 10.1016/j.juro.2016.03.152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE We describe histopathological, clinical and imaging findings among men with extraprostatic extension on prostate biopsy. MATERIALS AND METHODS We searched our institutional pathology database between 2004 and 2015 for pathology reports detailing extraprostatic extension on prostate biopsy in untreated patients. Patient characteristics, biopsy features, imaging interpretations and outcomes were examined. RESULTS Of 19,950 patients with prostate cancer on biopsy 112 had extraprostatic extension for a prevalence of 0.6% (95% CI 0.5-0.7). Most of the 112 patients had palpable, high grade (Gleason score 9), high volume disease, which was classified as high risk in 34 (30%), locally advanced in 17 (15%) and metastatic in 39 (35%). Most patients had 1 or 2 cores with extraprostatic extension, typically at the base and with concomitant perineural invasion. Extraprostatic extension was identified by magnetic resonance imaging in 32 of 40 patients (80%). Median followup in those who did not die was 1.3 years (IQR 0.3-4.2). Outcomes in the subgroup of 24 men treated with radical prostatectomy were consistent with high risk disease, including positive margins in 14 (58%), seminal vesicle invasion in 10 (42%) and lymph node invasion in 11 (46%). In the entire cohort the 3-year risks of metastasis and overall mortality were 32% (95% CI 22-44) and 37% (95% CI 27-50), respectively. We did not find evidence to suggest that the proportion of cores with cancer that also had extraprostatic extension was associated with overall mortality (p = 0.09). CONCLUSIONS Extraprostatic extension is a rare finding on prostate biopsy. It is strongly associated with other features of aggressive prostate cancer.
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Affiliation(s)
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Justin Lee
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Fine SW, Reuter VE. Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer. Histopathology 2012; 60:142-52. [PMID: 22212083 DOI: 10.1111/j.1365-2559.2011.04004.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past 25 years, our understanding of prostatic disease has evolved secondary to the increased detection, treatment and study of both benign and neoplastic prostatic lesions. The advent of aggressive prostate-specific antigen screening and standardization of extended transrectal needle biopsy protocols has resulted in significant stage migration and earlier detection of prostate cancers, a growing proportion of which are lower-volume posterior peripheral zone tumours. Consequently, an increased incidence of anterior-predominant prostate cancers has been observed. Given the histomorphological complexity of the prostate, these developments have necessitated a reconsideration of prostatic anatomy, biopsy strategies in the detection of anterior tumours and the determination and relevance of zonal origin in prostate cancer. This review will provide a contemporary update of these topics, while highlighting specific areas in which a keen understanding of prostatic histoanatomy may influence biopsy interpretation.
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Affiliation(s)
- Samson W Fine
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Osunkoya AO, Grignon DJ. Practical issues and pitfalls in staging tumors of the genitourinary tract. Semin Diagn Pathol 2012; 29:154-66. [DOI: 10.1053/j.semdp.2011.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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