Pretreatment stratification tools can help in clinical decision making in prostate cancer. To date, none incorporates well-established routinely reported adverse prognostic pathologic features such as intraductal carcinoma of prostate (IDC) or cribriform pattern 4 (CC).
To assess the impact of addition of CC and/or IDC on the Cancer of Prostate Risk Assessment (CAPRA) and National Cancer Comprehensive Network (NCCN) tools for predicting biochemical recurrence free survival (BCR-FS) and event-free survival (EFS) across multiple patient cohorts.
Matched prostate biopsies and radical prostatectomies from institutions in Toronto, Wisconsin and Rotterdam. The presence/absence of CC/IDC was recorded on all biopsies.
Relationship to outcome was assessed using Cox proportional hazard models, ANOVA and Harrell's concordance index.
We included 1326 patients (Toronto- 612, Wisconsin- 542, Rotterdam- 172) with median follow up of 4.2 years (IQR 2.9-6.4 years); 306 (23.1%) had CC/IDC on biopsy with 207 (20.9%) BCR and 154 (11.6%) events (metastases/death). Addition of CC/IDC improved stratification in CAPRA scores 3 to 5 for BCR-FS (c-index increase 0.633-0.658, P < .001) and scores 6-10 for EFS (c-index increase 0.653-0.697, P < .001). For NCCN, all risk groups apart from score 1 to 2 showed improvement in BCR-FS (c-index increase 0.599-0.636, P < 0.001) and EFS prediction (c-index increase 0.648-0.697, P < .001). Sub-analysis of grade group (GG) 2 biopsies showed similar findings. The retrospective nature and inclusion of cases only reported by genitourinary pathologists are study limitations.
The clinical benefit of the addition of CC/IDC to both CAPRA and NCCN pretreatment tools was validated in 3 cohorts, including the subset of biopsy GG2 prostate cancer patients.
Including additional pathologic features to existing pretreatment, clinical decision making tools improves the ability to predict prostate cancer recurrence, cancer spread and death of disease.
Clinical genitourinary cancer. 2023 Aug 01 [Epub ahead of print]
Michelle R Downes, Kristen N Liu, Yanhong Yu, Katherine Lajkosz, Lisa J Kroon, Eva Hollemans, Neil Fleshner, Antonio Finelli, Geert J L H van Leenders, Kenneth A Iczkowski, Theodorus H van der Kwast
Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Precision Diagnostic & Therapeutic Program, Toronto, Ontario, Canada. Electronic address: ., Department of Pathology, Medical College of Wisconsin, Milwaukee, WI., Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada., Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, Canada., Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands., Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada., Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Canada., Laboratory Medicine Program, University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37558528