Prognostic parameter for high risk prostate cancer patients at initial presentation

High-risk prostate cancer can be defined by a patient's Gleason score (GS), prostate-specific antigen (PSA) level, and clinical T (cT) stage, but a novel marker is needed due to heterogeneity of the disease. In this study, we evaluated whether intraductal carcinoma of the prostate (IDC-P) confirmed by needle biopsy is an adverse prognostic parameter for progression-free survival (PFS) and cancer-specific survival (CSS) in patients with high-risk prostate cancer.

We retrospectively evaluated 204 patients with high-risk prostate cancer treated by radical prostatectomy from 1991 to 2005 at Nagoya University and its affiliated hospitals. Data on each patient's PSA level, biopsy GS, cT stage, presence of Gleason pattern 5, presence of IDC-P, percentage of the core involved with cancer, and maximum percentage of the core involved with cancer were analyzed.

The median follow-up period was 108 months (range, 11-257 months). Forty-eight patients (24%) showed disease progression. Thirty-four patients (17%) died of the disease during follow-up. The IDC-P component was detected in 74 (36%) needle biopsy samples. The 5-, 10-, and 15-year CSS rates of the IDC-P-negative cases were 3.2%, 9.0%, and 23.7%; the corresponding rates of the IDC-P-positive cases were 23.9%, 33.7%, and 52.7%, respectively (P = 0.0001). In the Fine and Gray's model for PFS, IDC-P, maximum percentage of the core involved with cancer, and cT stage were significantly associated (P = 0.013, P = 0.003, P = 0.007). In the Fine and Gray's model for CSS, only IDC-P was significant (P = 0.027). In a multivariate Cox regression analysis, IDC-P (P = 0.04; hazard ratio [HR], 1.95) and maximum percentage of the core involved with cancer (P = 0.021; HR, 0.43) were significant factors in predicting overall survival (OS).

The presence of IDC-P in a needle biopsy was a prognostic factor for PFS, CSS, and OS in patients with high-risk prostate cancer who underwent radical prostatectomy. Multimodal pre-and/or post- surgical therapy may be needed when IDC-P is found in a needle biopsy specimen.

The Prostate. 2017 Nov 02 [Epub ahead of print]

Masashi Kato, Kyosuke Kimura, Akihiro Hirakawa, Yumiko Kobayashi, Ryo Ishida, Osamu Kamihira, Tsuyoshi Majima, Yasuhito Funahashi, Naoto Sassa, Yoshihisa Matsukawa, Ryohei Hattori, Momokazu Gotoh, Toyonori Tsuzuki

Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan., Department of Urology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan., Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan., Department of Urology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan., Department of Urology, Komaki City Hospital, Komaki, Japan., Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan., Department of Surgical Pathology, School of Medicine, Aichi Medical University, Nagakute, Japan.