Perineural invasion on prostate needle biopsy: an independent predictor of final pathologic stage

5142 Background: Approximately 232,090 new cases of prostate cancer were diagnosed in the U.S. in 2005. As the population ages and life expectancy increases, physicians will increasingly be faced with patients in their 70’s who can be expected to live for greater than 10 years. Many of these patients are screened for prostate cancer and may ultimately be evaluated by a urologist. Clinically significant prostate cancer is still diagnosed in men in this age group. To address this issue, we evaluated a large prostate biopsy database to assess the nature of prostate cancer diagnosed in elderly men in a referral population. Methods: A prospective database of 790 men who had undergone biopsy by a single urologist (CRP) was reviewed. Demographic data was recorded. Patients with Gleason score 7–10 were defined as having clinically significant disease. Multivariate regression analysis was performed to determine the relationship of increasing age with higher Gleason scores (7–10) on biopsy. We divided our patients into clinically applicable age groups of greater than or equal to 70 and less than 70 years. Results: The mean age of patients was 63.1 years. Men over 70 years old were more likely to have increased mean prostatic volume (P < 0.001), abnormal DRE (P < 0.001) and presence of prostate cancer (P < 0.001). Patients aged 70 or older had more than a three-fold increased risk of Gleason 7 or greater cancer (OR 3.32, p <0.001). An abnormal DRE (OR 3.65, p<0.001) and PSA >10 (OR 4.05, p <0.001) were also independently associated with a statistically significant chance of detecting Gleason 7 or greater cancer. Conclusions: Age is an independent predictor of clinically significant prostate cancer in a referral population. Patients who are 70 years or older with a 10-year life expectancy should be counseled that they are at higher risk of harboring clinically significant prostate cancer and should therefore be considered for prostate needle biopsy. [Table: see text] No significant financial relationships to disclose.

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Morphologic Criteria for the Diagnosis of Prostatic Adenocarcinoma in Needle Biopsy Specimens

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-0554-mcftdo ◽

2002 ◽

Vol 126 (5) ◽

pp. 554-561 ◽

Cited By ~ 8

Author(s):

Murali Varma ◽

Min W. Lee ◽

Pheroze Tamboli ◽

Richard J. Zarbo ◽

Rafael E. Jimenez ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Criteria ◽

Needle Biopsy ◽

Perineural Invasion ◽

Single Case ◽

Needle Core Biopsy ◽

Prostate Needle Biopsy ◽

Biopsy Specimens ◽

Retraction Clefting ◽

Hematoxylin Eosin

Abstract Context.—The diagnosis of prostate adenocarcinoma in needle core biopsy specimens is based on multiple diagnostic criteria and supportive features, most of which have been defined mainly from observations in transurethral resection and prostatectomy specimens. There is little information on the frequency with which diagnostic and supportive features of prostate cancer occur within benign glands. The few reports dealing with diagnostic criteria of cancer in needle biopsies have been largely confined to analysis of selected cases that posed particular diagnostic difficulty. Objective.—To analyze the frequency with which numerous diagnostic or supportive features of prostate cancer occur in an unselected, consecutively performed series of 18-gauge prostate needle biopsy specimens. Design.—Two hundred fifty consecutive 18-gauge prostate needle biopsy specimens (150 malignant and 100 benign) were evaluated, using hematoxylin-eosin–stained histologic sections. Results.—The frequency of the histologic features in malignant and benign glands was as follows: prominent nucleoli (94% and 25% of malignant and benign specimens, respectively), marginated nucleoli (88% and 7%), multiple nucleoli (64% and 0%), blue-tinged mucinous secretions (52% and 0%), intraluminal crystalloids (40.6% and 1%), intraluminal amorphous eosinophilic material (86.7% and 2%), collagenous micronodules (2% and 0%), glomerulations (15.3% and 0%), perineural invasion (22% and 0%), retraction clefting (38.6% and 7%), and invasion of fat (0.7% and 0%). Conclusions.—Since not all diagnostic or supportive features of cancer are evident in any single case of cancer, particularly in needle biopsy specimens in which sampling is limited, awareness of these data would be helpful in the assessment of small foci of atypical glands being considered for cancer.

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