Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy.

Eva Hollemans,Monique J Roobol,Esther I Verhoef,Jozien Helleman,Geert J L H Van Leenders,Chris H Bangma,John Rietbergen

doi:10.1111/his.14064

Eva Hollemans, Monique J Roobol + Show 5 more

Open Access

https://doi.org/10.1111/his.14064

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Journal: Histopathology	Publication Date: Apr 1, 2020
Citations: 19	License type: CC BY 4.0

Affiliation: Erasmus MC, Sint Franciscus Gasthuis

Abstract

AimsInvasive cribriform and intraductal carcinoma are associated with aggressive disease in Grade Group 2 (GG2) prostate cancer patients. However, the characteristics and clinical outcome of patients with GG2 prostate cancer without cribriform architecture (GG2−) as compared with those with Grade Group 1 (GG1) prostate cancer are unknown. The aim of this study was to investigate the clinical and pathological characteristics of GG1 and GG2− prostate cancer in radical prostatectomy specimens.Methods and resultsWe reviewed 835 radical prostatectomy specimens for Grade Group, pT stage, surgical margin status, and the presence of cribriform architecture. Biochemical recurrence‐free survival and metastasis were used as clinical outcomes. GG1 prostate cancer was seen in 207 patients, and GG2 prostate cancer was seen in 420 patients, of whom 228 (54%) showed cribriform architecture (GG2+) and 192 (46%) did not. GG2− patients had higher prostate‐specific antigen levels (9.4 ng/ml versus 7.0 ng/ml; P < 0.001), more often had extraprostatic extension (36% versus 11%; P < 0.001) and had more positive surgical margins (27% versus 17%; P = 0.01) than GG1 patients. GG2− patients had shorter biochemical recurrence‐free survival (hazard ratio 2.7, 95% confidence interval 1.4–4.9; P = 0.002) than GG1 patients. Lymph node and distant metastasis were observed neither in GG2− nor in GG1 patients, but occurred in 22 of 228 (10%) GG2+ patients.ConclusionIn conclusion, patients with GG2− prostate cancer at radical prostatectomy have more advanced disease and shorter biochemical recurrence‐free survival than those with GG1 prostate cancer, but both groups have a very low risk of developing metastasis.

Highlights

Active surveillance is increasingly being applied for patients with prostate cancer
Various studies demonstrated that Grade Group 2 (GG2) patients with invasive cribriform and/or intraductal carcinoma have worse disease outcomes than those without.[8,9,14,16,28,29]
It is generally accepted that GG2 patients have more aggressive disease than Grade Group 1 (GG1) patients, it is unclear whether this is still the case when those with aggressive cribriform pathology are excluded

Summary

Introduction

Active surveillance is increasingly being applied for patients with prostate cancer. Whereas most patientsGleason pattern 4 prostate cancer is a heterogeneous disease encompassing various histopathological growth patterns. Active surveillance is increasingly being applied for patients with prostate cancer. In previous sextant biopsy studies with long-term follow-up, biopsy GG2À patients had similar biochemical recurrence-free and disease-specific survival as GG1 patients.[16,17] it has been proposed that patients without cribriform architecture might be eligible for active surveillance.[15,16,17,18,19,20] prostate biopsies are subject to significant sampling errors with tumour undergrading in up to 40%, and there is low sensitivity for detection of cribriform architecture.[21,22,23] in contrast to radical prostatectomy specimens, minor high-grade patterns are always taken into account when prostate cancer biopsies are graded. The aim of this study was to compare the clinicopathological characteristics and biochemical recurrence-free survival of GG1 patients and GG2À patients in radical prostatectomy specimens

Methods

Results

Conclusion