Masashi Kato1, Kyosuke Kimura2, Akihiro Hirakawa3, Yumiko Kobayashi4, Ryo Ishida5, Osamu Kamihira6, Tsuyoshi Majima1, Yasuhito Funahashi1, Naoto Sassa1, Yoshihisa Matsukawa1, Ryohei Hattori7, Momokazu Gotoh1, Toyonori Tsuzuki8. 1. Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Urology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 3. Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan. 5. Department of Urology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan. 6. Department of Urology, Komaki City Hospital, Komaki, Japan. 7. Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan. 8. Department of Surgical Pathology, School of Medicine, Aichi Medical University, Nagakute, Japan.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Katharina Beyer; Lisa Moris; Michael Lardas; Anna Haire; Francesco Barletta; Simone Scuderi; Megan Molnar; Ronald Herrera; Abdul Rauf; Riccardo Campi; Isabella Greco; Kirill Shiranov; Saeed Dabestani; Thomas van den Broeck; Sujenthiran Arun; Mauro Gacci; Giorgio Gandaglia; Muhammad Imran Omar; Steven MacLennan; Monique J Roobol; Bahman Farahmand; Eleni Vradi; Zsuzsanna Devecseri; Alex Asiimwe; Jihong Zong; Sara J Maclennan; Laurence Collette; James NDow; Alberto Briganti; Anders Bjartell; Mieke Van Hemelrijck Journal: BMJ Open Date: 2022-04-04 Impact factor: 2.692