Author Reply

Abstract

All authors of the article “Predictive value of Cribriform and Intraductal Carcinoma for the Nomogram-Based Selection of Prostate Cancer Patients for Pelvic Lymph Node Dissection” sincerely appreciate the editorial comment. Although multiple retrospective studies have shown that nodal metastases are significantly more common in patients with CR/IDC, 1 Ericson KJ Wu SS Lundy SD Thomas LJ Klein EA McKenney JK. Diagnostic accuracy of prostate biopsy for detecting cribriform Gleason pattern 4 carcinoma and intraductal carcinoma in paired radical prostatectomy specimens: implications for active surveillance. The Journal of urology. 2020; 203: 311-319 Crossref PubMed Scopus (0) Google Scholar , 2 Wang L Deng FM Huang H Lee P Melamed J.M Zhou M. Gleason score 7 and 8 prostate cancer with cribriform morphology diagnosed in prostate biopsy is more likely to have seminal vesicle invasion and pelvic lymph node metastasis in radical prostatectomy. Mod Pathol. 2017; 30: 266A Google Scholar , 3 Downes MR Xu B van der Kwast TH. Cribriform architecture prostatic adenocarcinoma in needle biopsies is a strong independent predictor for lymph node metastases in radical prostatectomy. Eur J Cancer [Internet]. 2020; (Available from)https://linkinghub.elsevier.com/retrieve/pii/S0959804920305244 PubMed Google Scholar CR/IDC status did not improve the prediction of nodal metastases in our study. However, the “Letter to the Editor” clearly points out that presence of cribriform and intraductal carcinoma (CR/IDC) could allow the selection of intermediate-risk prostate cancer patients for extended pelvic lymph node dissection. Unfortunately, the number of intermediate-risk patients in our study leave us underpowered to validate the clinical benefit of a CR/IDC-enriched nomogram in this cohort. Recently, Yu et al. retrospectively demonstrated that the addition of CR/IDC status to pretreatment prostate cancer classification tools (ie, the Cancer of Prostate Risk Assessment and National Comprehensive Cancer Network [NCCN] risk scores) particularly improves the outcome stratification of intermediate-risk prostate cancer patients. 4 Yu Y Lajkosz K Finelli A Fleshner N van der Kwast TH Downes MR Impact of cribriform pattern 4 and intraductal prostatic carcinoma on National Comprehensive Cancer Network (NCCN) and Cancer of Prostate Risk Assessment (CAPRA) patient stratification. Modern Pathol. 2022; : 1-7 PubMed Google Scholar Alterations in the risk stratification may eventually affect treatment recommendations for these patients. Given the increased interest in integrating CR/IDC into clinical decision making, not only for guiding nodal dissections, but eg also for the selection of patient for active surveillance, 5 Ericson KJ Wu SS Lundy SD Thomas LJ Klein EA McKenney JK. Diagnostic accuracy of prostate biopsy for detecting cribriform Gleason pattern 4 carcinoma and intraductal carcinoma in paired radical prostatectomy specimens: implications for active surveillance. J Urol. 2020; 203: 311-319 Crossref PubMed Scopus (21) Google Scholar prospective studies evaluating the value of biopsy-identified CR/IDC for oncological outcomes and clinical decision making in intermediate-risk prostate cancer patients are needed.