Prognostic value of cribriform size, percentage, and intraductal carcinoma in Gleason Score 7 prostate cancer with Cribriform Gleason Pattern 4

Purpose Gleason grading is an important predictor of prostate cancer (PCa) outcomes. Studies using surrogate PCa end points suggest outcomes for Gleason score (GS) 7 cancers vary according to the predominance of pattern 4. These studies have influenced clinical practice, but it is unclear if rates of PCa mortality differ for 3 + 4 and 4 + 3 tumors. Using PCa mortality as the primary end point, we compared outcomes in Gleason 3 + 4 and 4 + 3 cancers, and the predictive ability of GS from a standardized review versus original scoring. Patients and Methods Three study pathologists conducted a blinded standardized review of 693 prostatectomy and 119 biopsy specimens to assign primary and secondary Gleason patterns. Tumor specimens were from PCa patients diagnosed between 1984 and 2004 from the Physicians' Health Study and Health Professionals Follow-Up Study. Lethal PCa (n = 53) was defined as development of bony metastases or PCa death. Hazard ratios (HR) were estimated according to original GS and standardized GS. We compared the discrimination of standardized and original grading with C-statistics from models of 10-year survival. Results For prostatectomy specimens, 4 + 3 cancers were associated with a three-fold increase in lethal PCa compared with 3 + 4 cancers (95% CI, 1.1 to 8.6). The discrimination of models of standardized scores from prostatectomy (C-statistic, 0.86) and biopsy (C-statistic, 0.85) were improved compared to models of original scores (prostatectomy C-statistic, 0.82; biopsy C-statistic, 0.72). Conclusion Ignoring the predominance of Gleason pattern 4 in GS 7 cancers may conceal important prognostic information. A standardized review of GS can improve prediction of PCa survival.

Download Full-text

Essential Updates in Grading, Morphotyping, Reporting, and Staging of Prostate Carcinoma for General Surgical Pathologists

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0334-ra ◽

2019 ◽

Vol 143 (5) ◽

pp. 550-564 ◽

Cited By ~ 5

Author(s):

Gladell P. Paner ◽

Jatin Gandhi ◽

Bonnie Choy ◽

Mahul B. Amin

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Gleason Score ◽

Prostate Carcinoma ◽

Multidisciplinary Care ◽

Tnm Staging ◽

International Consensus ◽

Gleason Pattern ◽

Consensus Conferences ◽

Worse Prognosis

Context.— Within this decade, several important updates in prostate cancer have been presented through expert international consensus conferences and influential publications of tumor classification and staging. Objective.— To present key updates in prostate carcinoma. Data Sources.— The study comprised a review of literature and our experience from routine and consultation practices. Conclusions.— Grade groups, a compression of the Gleason system into clinically meaningful groups relevant in this era of active surveillance and multidisciplinary care management for prostate cancer, have been introduced. Refinements in the Gleason patterns notably result in the contemporarily defined Gleason score 6 cancers having a virtually indolent behavior. Grading of tertiary and minor higher-grade patterns in radical prostatectomy has been clarified. A new classification for prostatic neuroendocrine tumors has been promulgated, and intraductal, microcystic, and pleomorphic giant cell carcinomas have been officially recognized. Reporting the percentage of Gleason pattern 4 in Gleason score 7 cancers has been recommended, and data on the enhanced risk for worse prognosis of cribriform pattern are emerging. In reporting biopsies for active surveillance criteria–based protocols, we outline approaches in special situations, including variances in sampling or submission. The 8th American Joint Commission on Cancer TNM staging for prostate cancer has eliminated pT2 subcategorization and stresses the importance of nonanatomic factors in stage groupings and outcome prediction. As the clinical and pathology practices for prostate cancer continue to evolve, it is of utmost importance that surgical pathologists become fully aware of the new changes and challenges that impact their evaluation of prostatic specimens.

Download Full-text

Prognostic value of Gleason score at positive surgical margin in prostate cancer. A systematic review and meta-analysis

European Urology Open Science ◽

10.1016/s2666-1683(20)33769-1 ◽

2020 ◽

Vol 19 ◽

pp. e1746

Author(s):

I. Lysenko ◽

K. Mori ◽

F. Quhal ◽

F. Janisch ◽

A. Briganti ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Gleason Score ◽

Prognostic Value ◽

Meta Analysis ◽

Surgical Margin ◽

Positive Surgical Margin

Download Full-text

Gleason Score 3 + 4=7 Prostate Cancer With Minimal Quantity of Gleason Pattern 4 on Needle Biopsy Is Associated With Low-risk Tumor in Radical Prostatectomy Specimen

The American Journal of Surgical Pathology ◽

10.1097/pas.0000000000000235 ◽

2014 ◽

Vol 38 (8) ◽

pp. 1096-1101 ◽

Cited By ~ 52

Author(s):

Cheng Cheng Huang ◽

Max Xiangtian Kong ◽

Ming Zhou ◽

Andrew B. Rosenkrantz ◽

Samir S. Taneja ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Needle Biopsy ◽

Low Risk ◽

Radical Prostatectomy Specimen ◽

Gleason Pattern ◽

Minimal Quantity ◽

Prostatectomy Specimen

Download Full-text

Primary Gleason pattern does not impact survival after permanent interstitial brachytherapy for Gleason score 7 prostate cancer

Cancer ◽

10.1002/cncr.22793 ◽

2007 ◽

Vol 110 (2) ◽

pp. 289-296 ◽

Cited By ~ 25

Author(s):

Gregory S. Merrick ◽

Robert W. Galbreath ◽

Wayne M. Butler ◽

Kent E. Waller ◽

Zachariah A. Allen ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Interstitial Brachytherapy ◽

Gleason Pattern

Download Full-text

Detecting circulating tumor cells (CTCs) in patients with high-risk, localized prostate cancer using the CellSearch platform.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15178 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15178-e15178

Author(s):

Sumanta Kumar Pal ◽

Clayton Lau ◽

Miaoling He ◽

Przemyslaw Twardowski ◽

Timothy G. Wilson ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Gleason Score ◽

Prognostic Value ◽

Localized Prostate Cancer ◽

Cellsearch System ◽

Mesenchymal Transition ◽

E Cadherin

e15178 Background: Enumeration of circulating tumor cells (CTCs) using the CellSearch platform has prognostic value in patients with metastatic castration resistant prostate cancer. However, the prognostic value of CTC enumeration in high-risk, localized prostate cancer (HRLPC) remains undefined. Methods: Patients with HRLPC (defined by ≥1 of the following criteria: ≥ cT3a disease, Gleason score 8-10, or PSA > 20 ng/mL) who have chosen prostatectomy for their definitive management were prospectively identified. Patients were consented to receive 4 sequential 30 mL blood draws, each collected in 3 separate 10 mL EDTA tubes. The first 2 blood draws were conducted 2 weeks prior and immediately prior to surgery, while the second 2 blood draws were conducted 4-6 weeks and 3 months following surgery. Within 4 hrs of blood collection, the white blood cell (WBC) fraction was pooled and Ficoll purified. The WBC fraction was transferred to a CellSave tube, and CTCs were enumerated using the CellSearch system. Expression of CD133 and E-cadherin was characterized using the CellSearch system in patients with detectable CTCs. Results: Within 3 monthsof study initiation in Nov 2011, 19 of a planned 37 patients have been accrued. Median age in the cohort was 65 (range, 51-74), and the number of patients with Gleason score 8-10, ≥ cT3a disease, or PSA > 20 ng/mL was 16, 4, and 2, respectively. The majority of patients (17/19, or 89%) had only one high-risk feature. Mean baseline PSA for the cohort was 11.4 (range, 3.4-37). CTCs were detectable in 67% of patients prior to surgery, 27% of patients at 1 month following surgery and 67% of patients at 3 months following surgery. Amongst those patients with detectable CTCs, the median count was 3 (range, 1-7). Further, in these patients, CD133 and E-cadherin were detected in 44% and 46% of specimens assessed, respectively. Full details of these analyses will be provided at the time of the meeting. Conclusions: Using a modified methodology, CTC enumeration using the CellSearch platform is feasible in patients with HRLPC. Interestingly, markers of epithelial-mesenchymal transition and stem cell lineage are detectable in a proportion of patients with localized disease.

Download Full-text

The presence of intraductal carcinoma of the prostate in needle biopsy as a prognostic parameter for prostate cancer patients with distant metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.237 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 237-237

Author(s):

Masashi Kato ◽

Toyonori Tsuzuki ◽

Kyosuke Kimura ◽

Naoto Sassa ◽

Yasushi Yoshino ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Distant Metastasis ◽

Needle Biopsy ◽

Univariate Analysis ◽

Intraductal Carcinoma ◽

Prognostic Parameter ◽

Carcinoma Of The Prostate ◽

The Core ◽

Gleason Pattern

237 Background: The presence of intraductal carcinoma of the prostate (IDC-P) is an adverse prognostic factor for prostate-specific antigen (PSA) failure, progression-free survival, and cancer-specific survival (CSS) in localized prostate cancer patients. However, there is no data indicating whether the presence of IDC-P can influence outcome in prostate cancer patients with distant metastasis at presentation. We aimed to evaluate whether IDC-P in needle biopsies is also an adverse prognostic parameter for CSS in prostate cancer patients with distant metastasis. Methods: We retrospectively evaluated 159 prostate cancer patients with distant metastasis who presented at the hospitals that the authors are affiliated with between 2002 and 2012 and reviewed the slides prepared from prostate needle biopsy specimens. Data on the patient age, performance status, clinical T stage, serum PSA, C-reactive protein, alkaline phosphatase (ALP), hemoglobin (Hb), albumin, serum calcium, biopsy Gleason score (> 8 or not), the presence of Gleason pattern 5, the percent of the core involved with cancer, and the maximum percent of a core involved with cancer were analyzed. Patient characteristics were analyzed using the Fisher's exact test. Multivariate Cox proportional hazard regression models were developed to predict CSS. Results: Patient median age was 73 years (range 47–90 years). The median serum PSA was 290 ng/mL (range 4.18–10,992 ng/mL). The median follow-up period was 36 months (range 3–120 months). IDC-P component was detected in 103 (64.8%) patients. There were 82 patients who died of the disease and 6 patients who died of other causes. Using univariate analysis, IDC-P (p = 0.0001), the presence of Gleason pattern 5 (p = 0.005), the percent of the core involved with cancer (p = 0.002), Hb (p = 0.001), and high ALP (p = 0.002) were all shown to be significantly associated with CSS. In the multivariate analysis, only IDC-P (p = 0.016; hazard ratio, 2.187) was significantly associated with CSS. Conclusions: The presence of IDC-P in needle biopsy is a prognostic parameter for CSS in patients with distant metastasis at presentation.

Download Full-text