Impact of Cribriform Pattern and Intraductal Carcinoma on Gleason 7 Prostate Cancer Treated with External Beam Radiotherapy.

To assess the impact of cribriform pattern and/or intraductal carcinoma (IDC) on Gleason 7 prostate cancer (PCa) treated with external beam radiotherapy (EBRT).

We evaluated men with Gleason 7 (Grade Group 2 and 3) PCa treated with dose-escalated EBRT +/- androgen deprivation, and reviewed biopsies for the presence of cribriform pattern and/or IDC. Endpoints included biochemical recurrence free survival (BRFS), distant metastasis free survival (DMFS), and disease specific survival (DSS).

Of 237 patients, median follow up was 117 months (range 3-236), and NCCN risk group was 24% favorable-intermediate risk, 53% unfavorable-intermediate risk, and 23% high risk. Rates of cribriform pattern without IDC, cribriform pattern with IDC, IDC without cribriform pattern, and neither morphology, were 36%, 13%, 0%, and 51%, respectively. On multivariable analysis (MVA), presence of cribriform pattern with IDC (HR 4.22; 95% CI 2.08-8.53; p<0.0001), PSA 10-20 ng/ml (1.97; 1.03-3.79; p=0.04), and PSA >20 ng/ml (2.26; 1.21-4.23; p=0.01) were associated with worse BRFS. On MVA, only cribriform pattern with IDC was associated with inferior DMFS (4.18; 1.43-12.28; p=0.01) and DSS (14.26; 2.75-74.04; p=0.0016). Factors associated with having cribriform pattern +/- IDC included Grade Group 3, high risk group, and ≥50% positive biopsy cores. When stratified by neither morphology present, cribriform pattern without IDC, and cribriform pattern with IDC, differences in BRFS (p=0.00042), DMFS (p=0.017), and DSS (p<0.0001) were statistically significant.

Cribriform pattern with IDC was associated with adverse outcomes among men with Gleason 7 PCa treated with ERBT, whereas cribriform pattern without IDC was not. Future studies may benefit from dichotomizing these two histologic entities.

The Journal of urology. 2019 May 06 [Epub ahead of print]

Martin C Tom, Jane K Nguyen, Roberta Lucianò, Omar Y Mian, Kevin L Stephans, Jay P Ciezki, Timothy D Smile, Wei Wei, Jesse K McKenney, Cristina Magi-Galluzzi, Rahul D Tendulkar

Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH., Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland , OH., Department of Pathology, IRCCS San Raffaele Scientific Institute , Milan , Italy., Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH., Department of Pathology, University of Alabama at Birmingham School of Medicine , Birmingham , AL.