The prognostic value of zonal origin and extraprostatic extension of prostate cancer for biochemical recurrence after radical prostatectomy

AbstractExtraprostatic extension (EPE) is a factor in determining pT3a stage in prostate cancer. However, the only distinction in EPE is whether it is focal or non-focal, causing diagnostic and prognostic ambiguity. We substaged pT3a malignancies using classification of EPE to improve personalized prognostication. We evaluated 465 radical prostatectomy specimens with a digital image analyzer by measuring the number, radial distance and two-dimensional square area of the EPE. The most significant cut-off value was proposed as an algorithm for the pT3a substaging system to predict biochemical recurrence (BCR). A combination of the radial distance and the number of EPEs predicted BCR the most effectively. The optimal cut-off criteria were 0.75 mm and 2 mm in radial distance and multifocal EPE (hazard ratio: 2.526, C-index 0.656). The pT3a was subdivided into pT3a1, < 0.75 mm and any number of EPEs; pT3a2, 0.75–2 mm and one EPE; and pT3a3, > 2 mm and any number of EPEs or 0.75–2 mm and ≥ 2 EPEs. This combined tier was highly significant in the prediction of BCR-free survival. The combination of radial distance and number of EPEs could be used to subdivide pT3a prostate cancer and may aid in the prediction of BCR.

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Perineural invasion by prostate cancer on MR/US fusion targeted biopsy is associated with extraprostatic extension and early biochemical recurrence after radical prostatectomy

Human Pathology ◽

10.1016/j.humpath.2017.06.017 ◽

2017 ◽

Vol 66 ◽

pp. 206-211 ◽

Cited By ~ 12

Author(s):

Matthew Truong ◽

Soroush Rais-Bahrami ◽

Jeffrey W. Nix ◽

Edward M. Messing ◽

Hiroshi Miyamoto ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Perineural Invasion ◽

Targeted Biopsy ◽

Extraprostatic Extension

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Prognostic value of perineural invasion in prostate needle biopsies: a population-based study of patients treated by radical prostatectomy

Journal of Clinical Pathology ◽

10.1136/jclinpath-2019-206300 ◽

2020 ◽

Vol 73 (10) ◽

pp. 630-635

Author(s):

Peter Ström ◽

Tobias Nordström ◽

Brett Delahunt ◽

Hema Samaratunga ◽

Henrik Grönberg ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Prognostic Value ◽

Perineural Invasion ◽

Population Based ◽

Advanced Stage ◽

Malignant Tumours ◽

Prostatic Biopsy ◽

Increased Risk

AimsDespite being one of the major pathways for the spread of malignant tumours, perineural invasion (PNI) has not conclusively been shown to have an independent prognostic value for prostate cancer. Prostatic biopsy constitutes the major pathology workload in prostate cancer and is the foundation for primary treatment decisions and for this reason we aimed to estimate the prognostic value of PNI in biopsies.MethodsWe followed 918 men who underwent radical prostatectomy (RP) from the prospective and population based STHLM3 study until biochemical recurrence with a median follow-up of 4.1 years. To strengthen the evidence, we combined the estimates from the largest studies targeting the prognostic value of PNI in the biopsy. We also estimated the OR of advanced stage as radical prostatectomy for PNI positive and negative men.ResultsThe estimated prognostic value based on our data suggested an approximately 50% increased risk of biochemical recurrence if PNI was present in the biopsy (p=0.06). Even though not statistically significant on the 5% level, this estimate is consistent with similar studies, and by combining the estimates there is in fact strong evidence in support of an independent prognostic value of PNI in the biopsy (p<0.0001). There was also an independent increased risk of advanced stage at RP for positive men (OR 1.85, p=0.005).ConclusionsThe evidence supporting a clinically relevant and independent prognostic value of PNI is strong enough to be considered for pathology reporting guidelines.

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Multifocal Extraprostatic Extension of Prostate Cancer

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz193 ◽

2019 ◽

Vol 153 (4) ◽

pp. 548-553 ◽

Cited By ~ 1

Author(s):

Lama Farchoukh ◽

William A Laframboise ◽

Joel B Nelson ◽

Sheldon Bastacky ◽

Anil V Parwani ◽

...

Keyword(s):

Prostate Cancer ◽

Multivariate Analysis ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Free Probability ◽

Prognostic Significance ◽

Prognostic Information ◽

Prognostic Features ◽

Prognostic Utility ◽

Extraprostatic Extension

Abstract Objectives To investigate the prognostic utility of multifocal extraprostatic extension (EPE) on biochemical recurrence after radical prostatectomy. Methods We conducted retrospective analysis of biochemical recurrence and prognostic pathologic variables in 673 men with stage pT3a/pT3b prostate cancer from 2000 to 2012. Extent of EPE on radical prostatectomy was divided into three groups: focal EPE (tumor dimension <0.8 mm), established (≥ 0.8 mm), and multifocal (more than one focus of EPE <0.8 mm). Results Type of EPE had significant effect on recurrence with progressively lower progression-free probability and higher recurrence probability from focal to established to multifocal. Multifocal and established tumors exhibited worse prognostic features and higher hazard ratio than focal. In multivariate analysis, established and multifocal were independent prognostic factors with the greatest adverse prognostic significance associated with multifocal. Conclusions Identification of multifocal EPE provides important prognostic information associated with increased likelihood of recurrence compared to focal and established tumors.

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