scholarly journals The Clinical Significance of Perineural Invasion by Prostate Cancer on Needle Core Biopsy

Author(s):  
Phoenix D. Bell ◽  
Yuki Teramoto ◽  
Pratik M. S. Gurung ◽  
Numbereye Numbere ◽  
Zhiming Yang ◽  
...  

Context.— Perineural invasion (PNI) by prostate cancer has been associated with adverse pathology, including extraprostatic extension. However, the significance of PNI quantification on prostate biopsy (PBx) remains unclear. Objective.— To compare radical prostatectomy (RP) findings and long-term outcomes in patients whose PBx had exhibited PNI. Design.— We assessed 497 consecutive patients undergoing sextant (6-site/≥12-core) PBx showing conventional adenocarcinoma followed by RP. Results.— PNI was found in 1 (n = 290)/2 (n = 132)/3 (n = 47)/4 (n = 19)/5 (n = 5)/6 (n = 4) of the sites/regions of PBx. Compared with a single PNI site, multiple PNIs were significantly associated with higher preoperative prostate-specific antigen, higher Grade Group (GG) on PBx or RP, higher pT or pN category, positive surgical margin, and larger estimated tumor volume. When compared in subgroups of patients based on PBx GG, significant differences in RP GG (GG1–3), pT (GG1–2/GG1–3/GG2/GG3), surgical margin status (GG1–3/GG3/GG5), or tumor volume (GG1–2/GG1–3/GG2/GG3) between 1 versus multiple PNIs were observed. Moreover, there were significant differences in prostate-specific antigen (PNI sites: 1–2 versus 3–6/1–3 versus 4–6/1–4 versus 5–6), RP GG (1–3 versus 4–6/1–4 versus 5–6), pT (1–2 versus 3–6/1–3 versus 4–6), pN (1–3 versus 4–6), or tumor volume (1–2 versus 3–6/1–4 versus 5–6). Outcome analysis revealed significantly higher risks of disease progression in the entire cohort or PBx GG1–2/GG1–3/GG2/GG3/GG5 cases showing 2 to 6 PNIs, compared with respective controls with 1-site PNI. In multivariate analysis, multisite PNI was an independent predictor for progression (hazard ratio = 1.556, P = .03). Conclusions.— Multiple sites of PNI on PBx were associated with worse histopathologic features in RP specimens and poorer prognosis. PNI may thus need to be specified, if present, in every sextant site on PBx, especially those showing GG1–3 cancer.

Author(s):  
Numbereye Numbere ◽  
Yuki Teramoto ◽  
Pratik M. S. Gurung ◽  
Takuro Goto ◽  
Zhiming Yang ◽  
...  

Context.— Seminal vesicle invasion (SVI) by prostate cancer (pT3b disease) has been considered as a key prognostic factor. Objective.— To assess the clinical impact of T3a lesions (ie, extraprostatic extension other than bladder neck invasion [BNI] or SVI [EPE], microscopic bladder neck invasion [mBNI]) in pT3b disease. Design.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients with pT3b disease, with versus without EPE/mBNI. Results.— Extraprostatic extension/mBNI was found in 219 (88.3%)/48 (19.4%) cases, respectively. Extraprostatic extension was significantly associated with higher preoperative prostate-specific antigen (PSA) level, higher rates of positive surgical margin (pSM) and lymphovascular invasion (LVI), and larger tumor volume. Similarly, mBNI was significantly associated with higher PSA level, higher rates of Grade Group(s) 4-5 or 5, pSM, LVI, and pN1, and larger tumor volume. Significant differences in all of these clinicopathologic features (except lymph node metastasis) between EPE−/mBNI+ or EPE+/mBNI− and EPE+/mBNI+ cases were also observed. Outcome analysis revealed that patients with EPE (P < .001) or mBNI (P < .001) had a significantly higher risk of disease progression than respective controls. Notably, there were significant differences in progression-free survival between EPE−/mBNI+ or EPE+/mBNI− cases and EPE−/mBNI− (P = .001) or EPE+/mBNI+ (P < .001) cases. In multivariate analysis, EPE (hazard ratio [HR] = 6.53, P = .009) and mBNI (HR = 2.33, P = .003), as well as EPE−/mBNI+ or EPE+/mBNI− (HR = 11.7, P = .01) and EPE+/mBNI+ (HR = 25.9, P = .002) (versus EPE−/mBNI−), showed significance for progression. Conclusions.— From these significant findings, we propose a novel pT3b subclassification: pT3b1 (SVI alone without EPE or mBNI), pT3b2 (SVI with either EPE or mBNI), and pT3b3 (SVI with both EPE and mBNI).


Author(s):  
Phoenix D. Bell ◽  
Yuki Teramoto ◽  
Pratik M. S. Gurung ◽  
Zhiming Yang ◽  
Hiroshi Miyamoto

Context.— Grading small foci of prostate cancer on a needle biopsy is often difficult, yet the clinical significance of accurate grading remains uncertain. Objective.— To assess if grading of limited adenocarcinoma on prostate biopsy specimen is critical. Design.— We studied 295 consecutive patients undergoing extended-sextant biopsy with only 1-core involvement of adenocarcinoma, followed by radical prostatectomy. Results.— The linear tumor lengths on these biopsy specimens were: less than 1 mm (n = 114); 1 mm or more or less than 2 mm (n = 82); 2 mm or more or less than 3 mm (n = 35); and 3 mm or more (n = 64). Longer length was strongly associated with higher Grade Group (GG) on biopsy or prostatectomy specimen, higher risk of extraprostatic extension/seminal vesicle invasion and positive surgical margin, and larger estimated tumor volume. When cases were compared based on biopsy specimen GG, higher grade was strongly associated with higher prostatectomy specimen GG, higher incidence of pT3/pT3b disease, and larger tumor volume. Outcome analysis further showed significantly higher risks for biochemical recurrence after radical prostatectomy in patients with 1 mm or more, 2 mm or more, 3 mm or more, GG2-4, GG3-4, GG4, less than 1 mm/GG2-4, less than 1 mm/GG3-4, less than 2 mm/GG3-4, 3 mm or more/GG2-4, or 3 mm or more/GG3-4 tumor on biopsy specimens, compared with respective control subgroups. In particular, 3 mm or more, GG3, and GG4 on biopsy specimens showed significance as independent prognosticators by multivariate analysis. Meanwhile, there were no significant differences in the rate of upgrading or downgrading after radical prostatectomy among those subgrouped by biopsy specimen tumor length (eg, <1 mm [44.7%] versus ≥1/<2 mm [41.5%] versus ≥2/<3 mm [45.7%] versus ≥3 mm [46.9%]). Conclusions.— These results indicate that pathologists still need to make maximum efforts to grade relatively small prostate cancer on biopsy specimens.


2017 ◽  
Vol 98 (6) ◽  
pp. 890-894 ◽  
Author(s):  
F A Guliev

Aim. To study the role of postoperative parameters in predicting the probability of development of biochemical recurrence in patients with prostate cancer with low pre-operative risk of its progression. Methods. 95 patients who underwent radical prostatectomy, were included in the study, the average age being 59.5±0.7 (44-76) years. The average levels of total and free prostate-specific antigen were 5.8±0.2 (1.71-9.9) and 1.03±0.07 (0.2-3.6) ng/ml respectively. Biochemical recurrence was defined as the level of prostate-specific antigen higher than 0.2 ng/ml after radical prostatectomy. Results. 8 (8.4%) patients during the follow-up period were diagnosed with biochemical recurrence. The average period to biochemical recurrence development was 45.8±6.7 (24-84) months. Pathomorphological examination revealed presence of tumor cells at surgical margin in 18 (18.9%) cases. Biochemical recurrence was diagnosed in 5 out of 77 (6.5%) patients with negative surgical margins and in 3 out of 18 (1.7%) patients with positive surgical margins. In our study, no correlation between the state of surgical margin and biochemical recurrence development was revealed (χ2=1.958; р=0.162). In the study group postoperative Gleason score was not prognostically significant as well (р=0.294). The average tumor volume in resected material was 11.8±1.0% (1-55%) of prostate volume (мм3). Extraprostatic extension was diagnosed in 10 (10.5%) cases. Results of univariate dispersion analysis of postoperative parameters revealed prognostic significance of tumor volume in removed specimen (р=0.007) and extracapsular extension (р=0.027). Conclusion. In our study we determined that tumor volume and extracapsular extention are independent risk factors for biochemical recurrence in prostate cancer patients with low pre-operative risk of disease progression.


Author(s):  
Numbereye Numbere ◽  
Yuki Teramoto ◽  
Pratik M. S. Gurung ◽  
Ying Wang ◽  
Zhiming Yang ◽  
...  

Context.— Seminal vesicle involvement by prostate cancer has generally been considered as a key prognosticator. Objective.— To assess the clinical significance of unilateral (Uni) versus bilateral (Bil) seminal vesicle invasion (SVI). Design.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients showing Uni-SVI (n = 139) versus Bil-SVI (n = 109). Results.— Tumor grade was significantly higher in Bil-SVI cases than in Uni-SVI cases. Additionally, Bil-SVI was significantly associated with a higher incidence of lymphovascular invasion, lymph node metastasis, or positive surgical margin, and larger estimated tumor volume. When the histopathologic features at SVI foci were compared, Grade Group (GG) 3-5/4-5/5 and cribriform morphology were significantly more often seen in Bil-SVI. Outcome analysis revealed that patients with Bil-SVI had a significantly higher risk of disease progression (P < .001) than patients with Uni-SVI. Significantly worse progression-free survival in patients with Bil-SVI was also observed in all subgroups examined, including those with no immediate adjuvant therapy (IAT) (n = 139; P = .01), IAT (n = 109; P = .001), pN0 disease (n = 153; P = .002), or pN1 disease (n = 93; P = .006). In multivariate analysis, Bil-SVI (versus Uni-SVI) showed significance for progression in the entire (hazard ratio [HR] = 1.83, P = .01), IAT (HR = 2.90, P = .006), and pN0 (HR = 2.05, P = .01) cohorts. Meanwhile, tumor grade at SVI (eg, GG4, GG5), as an independent predictor, was significantly associated with patient outcomes. Conclusions.— Bil-SVI was found to be strongly associated with worse histopathologic features on radical prostatectomy and poorer prognosis. Pathologists may thus need to report Uni-SVI versus Bil-SVI, along with other histopathologic findings, such as Gleason score, at SVI in prostatectomy specimens.


2020 ◽  
Vol 144 (8) ◽  
pp. 991-996
Author(s):  
Esther I. Verhoef ◽  
Charlotte F. Kweldam ◽  
Intan P. Kümmerlin ◽  
Daan Nieboer ◽  
Chris H. Bangma ◽  
...  

Context.— Prostate biopsy reports require an indication of prostate cancer volume. No consensus exists on the methodology of tumor volume reporting. Objective.— To compare the prognostic value of different biopsy prostate cancer volume parameters. Design.— Prostate biopsies of the European Randomized Study of Screening for Prostate Cancer were reviewed (n = 1031). Tumor volume was quantified in 6 ways: average estimated tumor percentage, measured total tumor length, average calculated tumor percentage, greatest tumor length, greatest tumor percentage, and average tumor percentage of all biopsies. Their prognostic value was determined by using either logistic regression for extraprostatic expansion (EPE) and surgical margin status after radical prostatectomy (RP), or Cox regression for biochemical recurrence-free survival (BCRFS) and disease-specific survival (DSS) after RP (n = 406) and radiation therapy (RT) (n = 508). Results.— All tumor volume parameters were significantly mutually correlated (R2 > 0.500, P < .001). None were predictive for EPE, surgical margin, or BCRFS after RP in multivariable analysis, including age, prostate-specific antigen, number of positive biopsies, and grade group. In contrast, all tumor volume parameters were significant predictors for BCRFS (all P < .05) and DSS (all P < .05) after RT, except greatest tumor length. In multivariable analysis including only all tumor volume parameters as covariates, calculated tumor length was the only predictor for EPE after RP (P = .02) and DSS after RT (P = .02). Conclusions.— All tumor volume parameters had comparable prognostic value and could be used in clinical practice. If tumor volume quantification is a threshold for treatment decision, calculated tumor length seems preferential, slightly outperforming the other parameters.


2016 ◽  
Vol 2 (3) ◽  
pp. 106-111
Author(s):  
Elena V Bocan ◽  
Ovidiu Mederle ◽  
Marius Raica

El cáncer de próstata es la malignidad más frecuente en los seres humanos en la actualidad. Los estudios post mortem hacen una estimación que el carcinoma de próstata (PCa) se propagará en 25% de los hombres con enfermedad establecida histológica-mente. Material y método: Se ha hecho una investigación retrospectiva sobre la expresión inmune histoquímica de antígeno prostático específico (PSA) en 84 pacientes ingresados en el hospital con sospecha clínica de cáncer de próstata. Fueron examinadas portaobjetos del archivo de biopsia de resección transuretral, biopsia por punción con aguja hueca y cirugía abierta. Portaobjetos tenidos fueron utilizados para el diagnóstico patológico y para la puntuacion de Gleason. Portaobjetos adicionales fueron tenidos para antígeno prostático específico y la reacción final del producto fue estimado en negativo (0), bajo/moderado positivo (+1) y positivo intenso (+2). Resultados: Hiperplasia benigna próstata  fue encontrado en 14 casos, y todos mostraron una reacción moderada /intensa para el antígeno prostático específico. Hiperplasia asociada basal de células fue siempre negativa. Carcinoma fue encontrado en 68 pacientes. La reacción inmune para antígeno prostático específico fue positiva en 88.2% casos, y encontramos una relación directa entre la intensidad de la reacción y la puntuacion de Gleason. Todas las carcinomas uroteliales y pequeñas fueron negativas. La reacción PSA ha detectado 39.68 % de los casos con invasión perineural en comparación con solamente 23.8% encontrado en los portaobjetos tenidos hematoxilina-eosina (H&E). La expresión inmune antígeno prostático específico no discrimina entre lesiones benignas atípicas y el carcinoma  bien diferenciados. Conclusión: Se concluye que la reacción inmune antígeno prostático específico ayuda mucho para el diagnóstico diferenciado, detección de la invasión perineural, y el metástasis ganglionar.  Prostate cancer is the most frequent malignancy in human nowadays. Postmortem studies estimate that prostate carcinoma (PCa) will spread in only 25% of men with histologically defined disease. Material and method: It was retrospectively investigated the immunohistochemical expression of prostate-specific antigen (PSA) in 84 patients admitted with clinical suspicion of prostate cancer. Slides were performed from archive biopsies taken by transurethral resection, core biopsy and open surgery. Routine stained slides were used for the pathologic diagnosis and Gleason score. Additional slides were stained for PSA, and the final reaction product was estimated as negative (0), weak/moderate positive (+1), and intense positive (+2). Results: Benign prostate hyperplasia was found in 14 cases, and all showed moderate/intense reaction for PSA. Associated basal cell hyperplasia was always negative. Carcinoma was found in 68 patients. The immunoreaction for PSA was positive in 88.2% cases, and we found a direct relationship between the intensity of the reaction and Gleason score. All urothelial and small carcinomas were negative. PSA immunoreaction detected 39.68% cases with perineural invasion as compared with only 23.8% found on hematoxylin-eosin (H&E) stained slides. PSA immunoexpression does not discriminate between atypical benign lesions and well-differentiated carcinoma. Conclusion: It is concluded that PSA immunoreaction is helpful for the differential diagnosis, detection of the perineural invasion, and lymph node metastases. 


2021 ◽  
Author(s):  
Hyeong Dong Yuk ◽  
Seok-Soo Byun ◽  
Sung Kyu Hong ◽  
Hakmin Lee

Abstract We evaluated the contribution of tumor volume (TV) to localized prostate cancer (PCa) patients’ prognosis. We retrospectively analyzed the data of 2,394 patients who underwent radical prostatectomy (RP) for localized PCa. The effect of TV volume on prostate cancer patients' prognosis was analyzed through Kaplan-Meier and Cox-proportional analysis. The mean prostate volume for all patients was 36.5 ± 15.4 cc, and the mean TV was 5.9 ± 8.3 cc. A significant positive relationship was observed between the classification by risk group in D’ Amico risk classification and the National Comprehensive Cancer Network risk group. (P < 0.001). The high TV showed significantly worse pathologic outcomes than the low TV in terms of high rates of extra-capsular extension, seminal vesicle invasion, and positive surgical margin (P < 0.05). The patients with high TV had significantly shorter biochemical recurrence-free survivals than those with low TV (P < 0.001). Finally, based on multivariate Cox-proportional analyses, TV was revealed to be an independent predictor of postoperative biochemical recurrence as both categorical (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.13–1.78, P = 0.003] and continuous variables (HR: 1.04, 95% CI: 1.04–1.05, P < 0.001). TV was revealed to be an independent prognostic factor in the postoperative biochemical recurrence. Patients with a high number of positive core and longer tumor length were significantly related to higher TV.


2020 ◽  
Author(s):  
Vojtěch Novák ◽  
Štěpán Veselý ◽  
Hana Lukšanová ◽  
Richard Průša ◽  
Otakar Čapoun ◽  
...  

Abstract Background: We aimed to explore the utility of prostate specific antigen (PSA) isoform [-2]proPSA and its derivatives for prediction of pathological outcome after radical prostatectomy (RP).Methods: Preoperative blood samples were prospectively and consecutively analyzed from 472 patients treated with RP for clinically localized prostate cancer at four medical centers. Measured parameters were PSA, free PSA (fPSA), fPSA/PSA ratio, [-2]proPSA (p2PSA), p2PSA/fPSA ratio and Prostate Health Index (PHI) (p2PSA/fPSA)*√PSA]. Logistic regression models were fitted to determine the accuracy of markers for prediction of pathological Gleason score (GS) ≥7, Gleason score upgrading, extracapsular extension of the tumor (pT3) and the presence of positive surgical margin (PSM). Results: Of 472 patients undergoing RP, 339 (72%) were found to have pathologic GS ≥ 7, out of them 178 (53%) experienced an upgrade from their preoperative GS=6. The findings of pT3 and PSM were present in 132 (28%) and 133 (28%) cases, respectively. At univariable analysis of all the preoperative parameters, PHI was the most accurate predictor of pathological GS ≥7, GS upgrading, pT3 disease and the presence of PSM. Adding of PHI into the base multivariable model increased significantly the accuracy for prediction of pathological GS and GS upgrading by 4.4% (p=0.015) and 5.0% (p=0.025), respectively. Conclusion: We found that PHI provides the highest accuracy in predicting prostate cancer aggressiveness and expansion of the tumor detected at final pathology. The ability of PHI to predict the risk of Gleason score upgrade may help to identify potentially high-risk patients among men with biopsy proven insignificant prostate cancer.


1990 ◽  
Vol 143 (4) ◽  
pp. 747-752 ◽  
Author(s):  
Alan W. Partin ◽  
H. Ballentine Carter ◽  
Daniel W. Chan ◽  
Jonathan I. Epstein ◽  
Joseph E. Oesterling ◽  
...  

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