Extraprostatic extension of prostatic carcinoma: Is its proximity to surgical margin or Gleason score important? - Abstract

OBJECTIVE: To examine the association between histopathological factors of extraprostatic cancer and outcome.

MATERIALS AND METHODS: Patients with EPE without positive margins, seminal vesicle or lymph node involvement were analyzed from a consecutive radical prostatectomy cohort of 1136 (2002-2006) for: 1) measurement of distance of EPE from the margin; 2) Gleason score of the EPE; 3) extent of EPE. Log-rank, Kaplan-Meier, Cox regression analyses were performed.

RESULTS: This study includes 194 pT3a, pN0, R0 cases with a median follow up of 5.4 years with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with Gleason score >8 in the extraprostatic portion showed increased incidence of BCR compared to those with Gleason scores of < 7 (p=0.03). The proximity of the EPE to the margin (0.01-7.5mm) did not correlate with BCR. On multivariable analysis, the extent of EPE, the Gleason score of the dominant nodule or of the EPE portion did not correlate with BCR.

CONCLUSION: Data from this study using current ISUP Gleason scoring and EPE criteria indicate that close proximity of EPE to the margin is not associated with recurrence. Gleason score >8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.

Written by:
Gupta R, O'Connell R, Haynes AM, Stricker PD, Barrett W, Turner JJ, Delprado W, Horvath LG, Kench JG.   Are you the author?
Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital; Sydney Medical School, University of Sydney; Cancer Research Program, The Kinghorn Cancer Centre/Garvan Institute of Medical Research.

Reference: BJU Int. 2014 Aug 19. Epub ahead of print.
doi: 10.1111/bju.12911

PubMed Abstract
PMID: 25138271

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