Prevalence of adverse pathology features in grade group 2 prostatectomy specimens with syn‐ or metachronous metastatic disease
- 8 December 2021
- journal article
- research article
- Published by Wiley in The Prostate
- Vol. 82 (3), 345-351
- https://doi.org/10.1002/pros.24279
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.Keywords
Funding Information
- Prostate Cancer Canada (D2017‐1879)
This publication has 31 references indexed in Scilit:
- Disease‐specific death and metastasis do not occur in patients with Gleason score ≤6 at radical prostatectomyBJU International, 2015
- Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancerLaboratory Investigation, 2015
- Prevalence of Prostate Cancer on Autopsy: Cross-Sectional Study on Unscreened Caucasian and Asian MenJNCI Journal of the National Cancer Institute, 2013
- Defining the threshold for significant versus insignificant prostate cancerNature Reviews Urology, 2013
- Gleason Score 7 Adenocarcinoma of the Prostate With Lymph Node Metastases: Analysis of 184 Radical Prostatectomy SpecimensArchives of Pathology & Laboratory Medicine, 2013
- Histopathological features of ductal adenocarcinoma of the prostate in 1,051 radical prostatectomy specimensVirchows Archiv, 2013
- Do Adenocarcinomas of the Prostate With Gleason Score (GS)≤6 Have the Potential to Metastasize to Lymph Nodes?The American Journal of Surgical Pathology, 2012
- Biopsy diagnosis of intraductal carcinoma is prognostic in intermediate and high risk prostate cancer patients treated by radiotherapyEuropean Journal of Cancer, 2012
- Digital Quantification of Five High-Grade Prostate Cancer Patterns, Including the Cribriform Pattern, and Their Association With Adverse OutcomeAmerican Journal of Clinical Pathology, 2011
- Pathologic Stage of Prostatic Ductal Adenocarcinoma at Radical ProstatectomyThe American Journal of Surgical Pathology, 2011