379 Background: Intraductal carcinoma of the prostate (IDCP) is a pathological pattern that involves atypical cells proliferating within the normal gland where basal cells are preserved. These exhibit cribriform morphology, a finding associated with poor prognosis. In addition to the TMPRSS2-ERG fusion gene, TP53, RB1, and PTEN deletions, and SPOP and HRR gene mutations, such as a BRCA mutations, are frequently detected in patients with IDCP. The National Comprehensive Cancer Network (NCCN) guidelines suggest that early genetic testing should be considered. However, IDCP recognition is notably low, and diagnosis requires skill. Methods: We selected 98 cases with "prostate cancer with high-grade prostatic intraepithelial neoplasia (PIN) in the background" by referring to the pathology reports of cases who underwent total prostatectomy for prostate cancer at our hospital between November 2011 and November 2021. Twelve cases were narrowed down to those that were considered suggestive of IDCP based on the pathology reports and reviewed by three pathologists to determine the presence of IDCP. These were additionally reviewed by three pathologists for the presence or absence of IDCP and a gene test of prostatectomy specimens was submitted for the relevant cases to determine the presence or absence of HRR gene mutations. Results: Five of the twelve cases were determined to be IDCP positive. The Gleason score of background prostate cancer was 4+3 in 3 cases, 4+4 in 1 case, and 4+5 in 1 case. Median postoperative follow-up was 37 months (22- 45 months); 3 of the 5 patients had no recurrence, 1 had recurrence at 2 years and 3 months resulting in additional local radio therapy (RT), and 1 patient died of other causes. Pathology genetic testing identified HRR-related genetic abnormalities, including BRCA mutations. Conclusions: We were able to establish IDCP cases from past high-grade PIN cases. As a number of HRR gene mutations of unknown pathological significance were detected, IDCP cases could be retrieved from past cases and genetic abnormalities could be identified efficiently. The findings of the study provide a possible approach to diagnose prostate cancer cases with genetic mutations at an early stage.
111 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 631 consecutive patients who underwent RARP from 9/2012 to 6/2016 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 555 men were age less than 75 and 76 men were ≥75. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and high elder groups. Operative time (median: 180 vs. 180 minutes) and estimated blood loss were similar in both groups. One of elder patients (1.4%) needed transfusion. Peri/post-operative complications over grade 3 were 0.9% in younger group and 1.4% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates in organ-confined (pT2) disease were also similar (13.4%, younger vs. 17.9%, elder). Continence at 3 months was 73% in elder patients as opposed to 77% in younger patients. Biochemical recurrences in short follow-up period (median 11.1 vs. 11.0 months) were observed 7.9% in elder patients as opposed 8.3% in younger patients. Conclusions: In our study, although urinary continence recovery in high elderly patients might show a short delay, RARP in high elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.
Background: Intraductal carcinoma of the prostate (IDCP) is a pathological pattern that involves atypical cells proliferating within the normal gland where basal cells are preserved. These exhibit cribriform morphology, a finding associated with poor prognosis. In addition to the TMPRSS2-ERG fusion gene, TP53, RB1, and PTEN deletions and HRR gene mutations, such as a BRCA mutations, are frequently detected in patients with IDCP. The National Comprehensive Cancer Network (NCCN) guidelines suggest that early genetic testing should be considered. However, IDCP recognition is notably low, and diagnosis requires skill. Methods: Among 1026 cases who underwent total prostatectomy for prostate cancer at our hospital between 2011 and 2021, we selected 98 cases with "prostate cancer with high-grade prostatic intraepithelial neoplasia (PIN) in the background" by referring to the pathology reports. Twelve cases which were considered suggestive of IDCP were reviewed by three pathologists to determine the presence of IDCP. Additionally a gene test of prostatectomy specimens was submitted for the relevant cases to determine the presence or absence of HRR gene mutations. Results: Five of the twelve cases were determined to be IDCP positive. Characteristics of the five cases are shown in the table. Pathology genetic testing identified HRR-related genetic abnormalities, including BRCA mutations. Conclusions: We were able to establish IDCP cases from past high-grade PIN cases. As a number of HRR gene mutations of unknown pathological significance were detected, IDCP cases could be retrieved from past cases and genetic abnormalities could be identified efficiently. The findings of the study provide a possible approach to diagnose prostate cancer cases with genetic mutations at an early stage. I am also currently working on a Visium for IDCP, and will present the results of that analysis on the day. Case 1 Case 2 Case 3 Case 4 Case 5 Age 61 73 80 69 75 iPSA (ng/ml) 31.5 5.5 88.02 7.2 4.67 Gleason Score 4+5 4+4 4+3 4+3 4+3 TNM pT2bN0M0 pT2bN0M0 pT3aN0M0 pT2aN0M0 pT2aN0M0 Follw up periods 28 months 37 months 22 months 45 months 42 months Recurrence None None Death by other causes None 27 months → RT Gene abnormality TOE1, FANCC, CHEK2 RECQL, TOE1, USH2A, PRPF3 APC, POLE, TOE1, ATR, PMS2 RET, BRCA2, TP53 BLM, POLE, BRCA1 Citation Format: Ryuta Watanabe, Osuke Arai, Tomoya Onishi, Toshio Kakuda, Terutaka Noda, Kenichi Nishimura, Tetsuya Fukumoto, Noriyoshi Miura, Mie Kurata, Yuki Miyauchi, Riko Kitazawa, Michael C. Haffner, Tadahiko Kikugawa, Takashi Saika. Detection of intraductal carcinoma of the prostate (IDCP) cases focusing on high-grade prostatic intraepithelial neoplasia (PIN) findings regarding invasive carcinoma of the prostate [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 774.
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