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Santucci D, Ragone R, Vergantino E, Vaccarino F, Esperto F, Prata F, Scarpa RM, Papalia R, Beomonte Zobel B, Grasso FR, Faiella E. Comparison between Three Radiomics Models and Clinical Nomograms for Prediction of Lymph Node Involvement in PCa Patients Combining Clinical and Radiomic Features. Cancers (Basel) 2024; 16:2731. [PMID: 39123458 PMCID: PMC11311324 DOI: 10.3390/cancers16152731] [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: 06/27/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
PURPOSE We aim to compare the performance of three different radiomics models (logistic regression (LR), random forest (RF), and support vector machine (SVM)) and clinical nomograms (Briganti, MSKCC, Yale, and Roach) for predicting lymph node involvement (LNI) in prostate cancer (PCa) patients. MATERIALS AND METHODS The retrospective study includes 95 patients who underwent mp-MRI and radical prostatectomy for PCa with pelvic lymphadenectomy. Imaging data (intensity in T2, DWI, ADC, and PIRADS), clinical data (age and pre-MRI PSA), histological data (Gleason score, TNM staging, histological type, capsule invasion, seminal vesicle invasion, and neurovascular bundle involvement), and clinical nomograms (Yale, Roach, MSKCC, and Briganti) were collected for each patient. Manual segmentation of the index lesions was performed for each patient using an open-source program (3D SLICER). Radiomic features were extracted for each segmentation using the Pyradiomics library for each sequence (T2, DWI, and ADC). The features were then selected and used to train and test three different radiomics models (LR, RF, and SVM) independently using ChatGPT software (v 4o). The coefficient value of each feature was calculated (significant value for coefficient ≥ ±0.5). The predictive performance of the radiomics models and clinical nomograms was assessed using accuracy and area under the curve (AUC) (significant value for p ≤ 0.05). Thus, the diagnostic accuracy between the radiomics and clinical models were compared. RESULTS This study identified 343 features per patient (330 radiomics features and 13 clinical features). The most significant features were T2_nodulofirstordervariance and T2_nodulofirstorderkurtosis. The highest predictive performance was achieved by the RF model with DWI (accuracy 86%, AUC 0.89) and ADC (accuracy 89%, AUC 0.67). Clinical nomograms demonstrated satisfactory but lower predictive performance compared to the RF model in the DWI sequences. CONCLUSIONS Among the prediction models developed using integrated data (radiomics and semantics), RF shows slightly higher diagnostic accuracy in terms of AUC compared to clinical nomograms in PCa lymph node involvement prediction.
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Affiliation(s)
- Domiziana Santucci
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
| | - Raffaele Ragone
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
| | - Elva Vergantino
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
| | - Federica Vaccarino
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
| | - Francesco Esperto
- Department of Urology, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.E.); (F.P.); (R.M.S.); (R.P.)
| | - Francesco Prata
- Department of Urology, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.E.); (F.P.); (R.M.S.); (R.P.)
| | - Roberto Mario Scarpa
- Department of Urology, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.E.); (F.P.); (R.M.S.); (R.P.)
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.E.); (F.P.); (R.M.S.); (R.P.)
| | - Bruno Beomonte Zobel
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
| | - Francesco Rosario Grasso
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
| | - Eliodoro Faiella
- Department of Diagnostic Imaging, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.R.); (E.V.); (F.V.); (B.B.Z.); (F.R.G.); (E.F.)
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Kim IE, Wang AH, Corpuz GS, Sprenkle PC, Leapman MS, Brito JM, Renzulli J, Kim IY. Association between pelvic lymph node dissection and survival among patients with prostate cancer treated with radical prostatectomy. Prostate Int 2024; 12:70-78. [PMID: 39036758 PMCID: PMC11255894 DOI: 10.1016/j.prnil.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Although the clinical benefits of pelvic lymph node dissection (PLND) at the time of radical prostatectomy for prostate cancer remain uncertain, major guidelines recommend PLND based on risk profile. Thus, the objective of this study was to examine the association between PLND and survival among patients undergoing RP stratified by Gleason grade group (GG) with the aim of allowing patients and physicians to make more informed care decisions about the potential risks and benefits of PLND. Materials and methods From the SEER-17 database, we examined overall (OS) and prostate cancer-specific (PCSS) survival of prostate cancer patients who underwent RP from 2010 to 2015 stratified by GG. We applied propensity score matching to balance pre-operative characteristics including race, age, PSA, household income, and housing status (urban/rural) between patients who did and did not undergo PLND for each GG. Statistical analyses included log-rank test and Kaplan-Meier curves. Results We extracted a matched cohort from 80,287 patients with GG1-5 who underwent RP. The median PSA value was 6.0 ng/mL, and the median age was 62-years-old. 49,453 patients underwent PLND (61.60%), while 30,834 (38.40%) did not. There was no difference in OS and PCSS between patients who received PLND and those who did not for all Gleason GG (OS-GG1: P = 0.20, GG2: P = 0.34, GG3: P > 0.05, GG4: P = 0.55, GG5: P = 0.47; PCSS-GG1: P = 0.11, GG2: P = 0.96, GG3: P = 0.81, GG4: P = 0.22, GG5: P = 0.14). Conclusions In this observational study, PLND at the time of RP was not associated with improved OS or PCSS among patients with cGS of 3 + 3, 3 + 4, 4 + 3, 4 + 4, 4 + 5, and 5 + 4. These findings suggest that until definitive clinical trials are completed, prostate cancer patients who have elected RP should be appropriately counseled on the potential risks and lack of proven survival benefit of PLND.
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Affiliation(s)
- Isaac E. Kim
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Aaron H. Wang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Preston C. Sprenkle
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Michael S. Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph M. Brito
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph Renzulli
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Isaac Yi Kim
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
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Lee HW, Kim E, Na I, Kim CK, Seo SI, Park H. Novel Multiparametric Magnetic Resonance Imaging-Based Deep Learning and Clinical Parameter Integration for the Prediction of Long-Term Biochemical Recurrence-Free Survival in Prostate Cancer after Radical Prostatectomy. Cancers (Basel) 2023; 15:3416. [PMID: 37444526 DOI: 10.3390/cancers15133416] [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: 05/12/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Radical prostatectomy (RP) is the main treatment of prostate cancer (PCa). Biochemical recurrence (BCR) following RP remains the first sign of aggressive disease; hence, better assessment of potential long-term post-RP BCR-free survival is crucial. Our study aimed to evaluate a combined clinical-deep learning (DL) model using multiparametric magnetic resonance imaging (mpMRI) for predicting long-term post-RP BCR-free survival in PCa. A total of 437 patients with PCa who underwent mpMRI followed by RP between 2008 and 2009 were enrolled; radiomics features were extracted from T2-weighted imaging, apparent diffusion coefficient maps, and contrast-enhanced sequences by manually delineating the index tumors. Deep features from the same set of imaging were extracted using a deep neural network based on pretrained EfficentNet-B0. Here, we present a clinical model (six clinical variables), radiomics model, DL model (DLM-Deep feature), combined clinical-radiomics model (CRM-Multi), and combined clinical-DL model (CDLM-Deep feature) that were built using Cox models regularized with the least absolute shrinkage and selection operator. We compared their prognostic performances using stratified fivefold cross-validation. In a median follow-up of 61 months, 110/437 patients experienced BCR. CDLM-Deep feature achieved the best performance (hazard ratio [HR] = 7.72), followed by DLM-Deep feature (HR = 4.37) or RM-Multi (HR = 2.67). CRM-Multi performed moderately. Our results confirm the superior performance of our mpMRI-derived DL algorithm over conventional radiomics.
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Affiliation(s)
- Hye Won Lee
- Samsung Medical Center, Department of Urology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Eunjin Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Inye Na
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seong Il Seo
- Samsung Medical Center, Department of Urology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hyunjin Park
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon 16419, Republic of Korea
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Doan P, Katelaris A, Scheltema MJ, Hayen A, Amin A, Siriwardana A, Tran M, Geboers B, Gondoputro W, Haynes AM, Matthews J, Delprado W, Stricker PD, Thompson J. The relationship between biochemical recurrence and number of lymph nodes removed during surgery for localized prostate cancer. BMC Urol 2023; 23:68. [PMID: 37118731 PMCID: PMC10148506 DOI: 10.1186/s12894-023-01228-3] [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: 11/18/2022] [Accepted: 03/28/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE To assess whether completeness of pelvic lymph node dissection (PLND) as measured by lymph node yield reduces biochemical recurrence (BCR) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa), stratified according to Briganti nomogram-derived risk (≥5% vs. < 5%) of lymph node invasion (LNI). METHODS Retrospective study of 3724 men who underwent RP between January 1995 and January 2015 from our prospectively collected institutional database. All men included had minimum five years follow-up and were not given androgen deprivation therapy or radiotherapy prior to BCR. Primary endpoint was time to BCR as defined by PSA > 0.2ng/ml. Patients were analysed according to Briganti Nomogram derived risk of 'low-risk' (< 5%) vs. 'high-risk' (≥ 5%). Extent of PLND was analysed using number of nodes yielded at dissection as a continuous variable as well as a categorical variable: Group 1 (limited, 1-4 nodes), Group 2 (intermediate, 5-8 nodes) and Group 3(extensive, ≥9 nodes). RESULTS Median follow-up in the overall cohort was 79.7 months and 65% of the total cohort underwent PLND. There were 2402 patients with Briganti risk of LNI < 5% and 1322 with a Briganti risk of LNI ≥5%. At multivariate analysis, only PSA (HR1.01, p < 0.001), extracapsular extension at RP (HR 1.86, p < 0.001), positive surgical margin (HR 1.61, p < 0.001) and positive lymph node on pathology (HR 1.52, p = 0.02) were independently associated with BCR. In the high-risk group, increased nodal yield at PLND was associated with reduction in risk of BCR (HR 0.97, 95%CI 0.95-1.00 p = 0.05, Cochran Mantel Haenszel test, p < 0.05: respectively). In the low-risk group increased number of nodes at PLND did not reduce risk of BCR. CONCLUSIONS In this study of extent of PLND at RP, higher nodal yield did not reduce risk of BCR in low-risk men (Briganti risk < 5%), however there was a weak benefit in terms of reduced long-term risk of BCR in high-risk men (Briganti risk ≥5%).
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Affiliation(s)
- Paul Doan
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia.
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia.
| | - Athos Katelaris
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Matthijs J Scheltema
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
- Departments of Urology and Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, University of Technology, Sydney, NSW, Australia
| | - Amer Amin
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Amila Siriwardana
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Minh Tran
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Bart Geboers
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
- Departments of Urology and Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - William Gondoputro
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Anne Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Jayne Matthews
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | | | - Phillip D Stricker
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - James Thompson
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
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Nabian N, Ghalehtaki R, Couñago F. Necessity of Pelvic Lymph Node Irradiation in Patients with Recurrent Prostate Cancer after Radical Prostatectomy in the PSMA PET/CT Era: A Narrative Review. Biomedicines 2022; 11:biomedicines11010038. [PMID: 36672547 PMCID: PMC9855373 DOI: 10.3390/biomedicines11010038] [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: 10/04/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
The main prostate cancer (PCa) treatments include surgery or radiotherapy (with or without ADT). However, none of the suggested treatments eliminates the risk of lymph node metastases. Conventional imaging methods, including MRI and CT scanning, are not sensitive enough for the diagnosis of lymph node metastases; however, the novel imaging method, PSMA PET/CT scanning, has provided valuable information about the pelvic LN involvement in patients with recurrent PCa (RPCa) after radical prostatectomy. The high sensitivity and negative predictive value enable accurate N staging in PCa patients. In this narrative review, we summarize the evidence on the treatment and extent of radiation in prostate-only or whole-pelvis radiation in patients with positive and negative LN involvement on PSMA PET/CT scans.
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Affiliation(s)
- Naeim Nabian
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran P.O. Box 1419733141, Iran
- Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran P.O. Box 1419733141, Iran
| | - Reza Ghalehtaki
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran P.O. Box 1419733141, Iran
- Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran P.O. Box 1419733141, Iran
- Correspondence:
| | - Felipe Couñago
- Department of Radiation Oncology, San Francisco de Asís and La Milagrosa Hospitals, GenesisCare, 28010 Madrid, Spain
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Rocco B, Eissa A, Gaia G, Assumma S, Sarchi L, Bozzini G, Micali S, Calcagnile T, Sighinolfi MC. Pelvic lymph node dissection in prostate and bladder cancers. Minerva Urol Nephrol 2022; 74:680-694. [PMID: 36197698 DOI: 10.23736/s2724-6051.22.04904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Prostate cancer and bladder cancer accounts for approximately 13.5% and 3% of all male cancers and all newly diagnosed cancers (regardless sex), respectively. Thus, these cancers represent a major health and economic burden globally. The knowledge of lymph node status is an integral part of the management of any solid tumor. In the urological field, pelvic lymph node dissection (PLND) is of paramount importance in the diagnosis, management, and prognosis of prostate and bladder cancers. However, PLND may be associated with several comorbidities. In this narrative review, the most recent updates concerning the patterns and incidence of lymph node metastasis, the role of different imaging studies and nomograms in determining patients' eligibility for PLND, and the anatomical templates of PLND in urologic patients with bladder or prostate cancer will be discussed.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Giorgia Gaia
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria C Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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Małkiewicz B, Kiełb P, Karwacki J, Czerwińska R, Długosz P, Lemiński A, Nowak Ł, Krajewski W, Szydełko T. Utility of Lymphadenectomy in Prostate Cancer: Where Do We Stand? J Clin Med 2022; 11:jcm11092343. [PMID: 35566471 PMCID: PMC9103547 DOI: 10.3390/jcm11092343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this review is to summarize the current knowledge on lymph node dissection (LND) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Despite a growing body of evidence, the utility and therapeutic and prognostic value of such an approach, as well as the optimal extent of LND, remain unsolved issues. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, which limits the possibility of establishing clear recommendations. This indicates the need for further robust and adequately designed high-quality clinical trials.
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Affiliation(s)
- Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Jakub Karwacki
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Róża Czerwińska
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Paulina Długosz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (J.K.); (R.C.); (P.D.); (Ł.N.); (W.K.); (T.S.)
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Ma C, Downes M, Jain R, Ientilucci M, Fleshner N, Perlis N, van der Kwast T. Prevalence of adverse pathology features in grade group 2 prostatectomy specimens with syn- or metachronous metastatic disease. Prostate 2022; 82:345-351. [PMID: 34878188 DOI: 10.1002/pros.24279] [Citation(s) in RCA: 8] [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: 08/12/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND To validate the importance of recently established adverse histopathology features (cribriform pattern and intraductal carcinoma) as contra-indication for deferred treatment of Gleason score 7 (3 + 4) (grade group [GG] 2) prostate cancer, we investigated their frequency in GG2 radical prostatectomies with syn- or metachronous metastatic disease. METHODS GG2 prostatectomy specimens of patients with concomitant lymph node metastasis or distant metastasis at follow-up were identified in a clinical database of a tertiary care center and their pathology was reviewed for pathological stage, lymphovascular invasion, Gleason grade 4 subpatterns, presence of tertiary grade 5, and ductal adenocarcinoma histology. A control group of 99 GG2 prostatectomy specimens who had no metastatic disease (controls) was reviewed for the same adverse pathological features. RESULTS Of 1860 GG2 prostatectomy specimens (operated between 2002 and 2020), 45 (2.4%) had concurrent regional lymph node metastases or distant metastases at follow-up. Pathological stage distribution of cases and controls was 24% and 79% pT2, 42% and 15% pT3a, 33% and 6.1% pT3b -T4, respectively (p < 0.001). Eleven of 45 cases (24%) had ≤10% Gleason grade 4 component. Cribriform pattern or intraductal carcinoma was present in 84% of cases versus 34% of controls (p < 0.001), tertiary grade 5 in 16% of cases versus 5% controls (p = 0.05) and ductal adenocarcinoma in 16% of cases versus 2% of controls (p = 0.004). Among the seven cases without cribriform or intraductal carcinoma, two displayed ductal adenocarcinoma features. CONCLUSIONS Well-established unfavorable histopathologic features (intraductal and cribriform pattern carcinoma, ductal adenocarcinoma) are represented in about 90% of GG2 prostate cancers with local or distant metastatic disease and are much less common (38%) in those without metastatic disease. Strikingly, about 25% of GG2 prostatectomy cases with metastatic disease had an organ-confined disease and/or a small percentage of Gleason grade 4 pattern. This further emphasizes the relative importance of these adverse histopathological features (cribriform, intraductal, and ductal adenocarcinoma) rather than percentage Gleason grade 4 as contra-indicator of deferred treatment for patients with GG2 prostate cancer.
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Affiliation(s)
- Christopher Ma
- Department of Pathology, Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Ontario, Canada
| | - Michelle Downes
- Department of Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rahi Jain
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Marc Ientilucci
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Theodorus van der Kwast
- Department of Pathology, Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Ontario, Canada
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