PURPOSE: Although the development of metastases correlates closely with depth of invasion in many tumor types, it is unclear if invasion into, but not through, the prostatic pseudocapsule has a negative impact on prognosis similar to extraprostatic extension (EPE).
We aimed to define the impact of pseudocapsular invasion (PCI) on the risk of post-prostatectomy biochemical recurrence (BCR).
MATERIALS AND METHODS: Patients with pT2-3a prostate cancer were identified from a prospectively recorded database. Patients with pT2 disease were categorized according to the presence or absence of PCI. The impact of PCI on BCR was determined by univariable and multivariable Cox regression analysis.
RESULTS: From a cohort of 1338, we identified 595 patients with organ-confined cancer positive for PCI. Compared to tumors without evidence of PCI, the presence of PCI was positively associated with tumors of higher Gleason grade (p< 0.001) and tumor volume (1.2 vs. 1.9 cc, p< 0.001). On univariable analysis, there was no difference in BCR-free survival between patients with or without PCI, although patients with EPE had a significantly lower BCR-free survival (p< 0.001). This was confirmed on multivariable analysis, where EPE was a significant independent predictor of BCR (HR 1.53, p=0.018), whereas the presence of PCI had no effect (HR 0.81, p=0.33).
CONCLUSION: PCI is not a pathological feature associated with an adverse outcome post-prostatectomy. This indicates that depth of tumor invasion is not a continuum of risk, and access to the periprostatic adipose tissue is a more important determinant of disease behavior than the presence of an invasive phenotype.
Written by:
Kapoor J, Namdarian B, Pedersen J, Hovens C, Moon D, Peters J, Costello AJ, Ruljancich P, Corcoran NM. Are you the author?
Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia; Australian Prostate Cancer Centre Epworth, Richmond, VIC, Australia; TissuPath Pty Ltd, Hawthorn, VIC, Australia; Department of Urology, Box Hill Hospital, Box Hill, VIC, Australia.
Reference: J Urol. 2013 Jun 29. pii: S0022-5347(13)04667-3.
doi: 10.1016/j.juro.2013.06.050
PubMed Abstract
PMID: 23820055
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