Disease-specific survival of patients with invasive cribriform and intraductal prostate cancer at diagnostic biopsy

Abstract

Invasive cribriform and intraductal carcinoma in radical prostatectomy specimens have been associated with an adverse clinical outcome. Our objective was to determine the prognostic value of invasive cribriform and intraductal carcinoma in pre-treatment biopsies on time to disease-specific death. We pathologically revised the diagnostic biopsies of 1031 patients from the first screening round of the European Randomized Study of Screening for Prostate Cancer (1993Cancer ( -2000. Ninety percent of all patients (n = 923) had received active treatment, whereas 10% (n = 108) had been followed by watchful waiting. The median follow-up was 13 years. Patients who either had invasive cribriform growth pattern or intraductal carcinoma were categorized as CR/IDC+. The outcome was disease-specific survival. Relationships with outcome were analyzed using multivariable Cox regression and log-rank analysis. In total, 486 patients had Gleason score 6 (47%) and 545 had ≥ 7 (53%). The 15-year disease-specific-survival probabilities were 99% in Gleason score 6 (n = 486), 94% in CR/IDC − Gleason score ≥ 7 (n = 356) and 67% in CR/IDC+ Gleason score ≥ 7 (n = 189). CR/IDC − Gleason score 3+4 = 7 patients did not have statistically different survival probabilities from those with Gleason score 6 (P = 0.30), while CR/IDC+ Gleason score 3+4 = 7 patients did (P o0.001). In multivariable analysis, CR/IDC+ status was independently associated with a poorer disease-specific survival (HR 2.6, 95% CI 1.4-4.8, P = 0.002). We conclude that CR/IDC+ status in prostate cancer biopsies is associated with a worse disease-specific survival. Our findings indicate that men with biopsy CR/IDC − Gleason score 3+4 = 7 prostate cancer could be candidates for active surveillance, as these patients have similar survival probabilities to those with Gleason score 6.

Gleason grade grouping of prostate cancer is of prognostic value in Asian men

“…Secondly, this might be a reflection of the heterogeneity of Gleason pattern 4, which is not addressed by GG and can have a significant prognostic/clinical impact. Kweldam et al 17 reported the lack of consensus between expert genitourinary pathologists on ill-formed or complex fused glands, describing this as a borderline pattern of unknown prognostic significance; while cribriforming and intraductal patterns 4 are less ambiguous, and associated with poorer prognosis,18 often leading to upgrading of GG2 disease at RP 19. Reflecting these challenges, reporting the proportion of pattern 4 cancer on biopsies has recently been recommended by the ISUP as a Gleason grading refinement 20.…”

An updated review of cribriform carcinomas with emphasis on histopathological diagnosis and prognostic significance

“…7,12,13 In 2005, the International Society of Urological Pathology (ISUP) assigned a Gleason grade 4 rather than Gleason grade 3 for a cribriform pattern. 8,9 In 2009, Lotan et al showed that there was often histologic continuity between glomeruloid glands and cribriform pattern.…”

Concordance of biopsy and prostatectomy diagnosis of intraductal and cribriform carcinoma in a prospectively collected data set

“…Now, it is well established that IDC represents a histopathological entity associated with higher Gleason score and advanced pathological stage . Moreover, both in prostate biopsy and radical prostatectomy specimens, its presence is a strong and independent prognosticator of metastatic disease and death of disease . Further, its presence in biopsies was shown to be associated with more advanced pathological stage at the time of prostatectomy .…”