The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed.
To compare oncological outcomes for conventional and UH PCa in men with localized disease treated with curative intent.
A systematic review adhering to the Referred Reporting Items for Systematic Reviews and Meta-Analyses was prospectively registered on PROSPERO (CRD42022296013) was performed in July 2021.
We screened 3651 manuscripts and identified 46 eligible studies (reporting on 1 871 814 men with conventional PCa and 6929 men with 10 different PCa UHs). Extraprostatic extension and lymph node metastases, but not positive margin rates, were more common with UH PCa than with conventional tumors. PCa cases with cribriform pattern, intraductal carcinoma, or ductal adenocarcinoma had higher rates of biochemical recurrence and metastases after radical prostatectomy than for conventional PCa cases. Lower cancer-specific survival rates were observed for mixed cribriform/intraductal and cribriform PCa. By contrast, pathological findings and oncological outcomes for mucinous and prostatic intraepithelial neoplasia (PIN)-like PCa were similar to those for conventional PCa. Limitations of this review include low-quality studies, a risk of reporting bias, and a scarcity of studies that included radiotherapy.
Intraductal, cribriform, and ductal UHs may have worse oncological outcomes than for conventional and mucinous or PIN-like PCa. Alternative treatment approaches need to be evaluated in men with these cancers.
We reviewed the literature to explore whether prostate cancers with unconventional growth patterns behave differently to conventional prostate cancers. We found that some unconventional growth patterns have worse outcomes, so we need to investigate if they need different treatments. Urologists should be aware of these growth patterns and their clinical impact.
European urology. 2023 Apr 27 [Epub ahead of print]
Giancarlo Marra, Geert J L H van Leenders, Fabio Zattoni, Claudia Kesch, Pawel Rajwa, Philip Cornford, Theodorus van der Kwast, Roderick C N van den Bergh, Erik Briers, Thomas Van den Broeck, Gert De Meerleer, Maria De Santis, Daniel Eberli, Andrea Farolfi, Silke Gillessen, Nikolaos Grivas, Jeremy P Grummet, Ann M Henry, Michael Lardas, Matt Lieuw, Estefania Linares Espinós, Malcolm D Mason, Shane O'Hanlon, Inge M van Oort, Daniela E Oprea-Lager, Guillaume Ploussard, Olivier Rouvière, Ivo G Schoots, Johan Stranne, Derya Tilki, Thomas Wiegel, Peter-Paul M Willemse, Nicolas Mottet, Giorgio Gandaglia, European Association of Urology Young Academic Urologists Prostate Cancer Working Group, the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines Panel on Prostate Cancer
Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy. Electronic address: ., Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands., Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy., Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany., Department of Urology, Medical University of Silesia, Zabrze, Poland; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Liverpool University Hospitals NHS Trust, Liverpool, UK., Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Canada., Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands., Patient advocate, Hasselt, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium., Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; Department of Urology, Charité Universitätsmedizin, Berlin, Germany., Department of Urology, University Hospital Zurich, Zurich, Switzerland., Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; University of Bern, Bern, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Surgery, Central Clinical School, Monash University, Caulfield North, Australia., Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK., Department of Urology, Metropolitan General Hospital, Athens, Greece., Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK., Department of Urology, Hospital Universitario La Paz, Madrid, Spain., Division of Cancer and Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK., Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland., Department of Urology, Radboudumc, Nijmegen, The Netherlands., Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands., La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Onocopole, Toulouse, France., Department of Urinary and Vascular Imaging, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France., Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenborg, Sweden., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands., Centre Hospitalo-Universitaire de Saint Etienne, Saint Etienne, France., Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.