Clinical, pathologic, and oncologic findings of radical prostatectomy patients with extraprostatic extension diagnosed on pre-operative prostate biopsy

Prostatic adenocarcinoma (PCa) with extraprostatic extension (EPE) detected on prostate needle biopsy (PNB) is an uncommon finding. We aimed to describe the clinical and pathologic findings in a large cohort of PCa patients treated with radical prostatectomy (RP) who had EPE identified on PNB.

Using our institutional pathology database, we identified 83 PCa cases with EPE on PNB between 2000-2018 who underwent treatment with RP and had clinical follow-up information. Clinical and pathologic outcomes were examined.

Sixty-five percent (54/83) of patients presented with clinical stage ≥T2 disease. On biopsy, 60% (50/83) of patients had grade group (GG) 4-5, and 81% (66/83) had perineural invasion. EPE was confirmed in the RP specimen in 98% (81/83) of cases. At RP, 59% (49/83) had positive surgical margins, 45% (37/83) had seminal vesicle invasion, and 37% (30/83) had lymph node involvement. Median length of follow-up after RP was 2 years. Overall, 45% (34/76) of patients received post-operative radiation at a median of 1 year after RP; 11% (8/73) received chemotherapy at a median of 2 years after RP. The 3-year biochemical recurrence (BCR)-free survival rate was 48.4% (95% CI 0.345-0.610), and the 3-year metastasis-free survival rate was 75.2% (95% CI 0.603-0.851).

Patients with EPE detected on PNB almost always have extraprostatic disease and markedly adverse pathology at RP. Many experience BCR, and most will require multi-modal therapy. These data can be useful in counseling such patients with regards to management approach and expected outcomes after surgery.

The Journal of urology. 2018 Nov 08 [Epub ahead of print]

Farzana A Faisal, Jeffrey J Tosoian, Misop Han, Katarzyna J Macura, Christian P Pavlovich, Tamara L Lotan

Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ., Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Current address: Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: ., Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ., Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ., Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ., Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: .

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