Abstract
AimsInvasive cribriform and/or intraductal carcinoma have been identified as independent adverse parameters for prostate cancer outcome. Little is known on biopsy undersampling of cribriform architecture. Our aim was to determine the extent of cribriform architecture undersampling and to find predictive factors for identifying false cribriform‐negative cases.Methods and resultsWe reviewed 186 matched prostate biopsies and radical prostatectomy specimens. Of 97 biopsy grade group 2 (Gleason score 3 + 4 = 7) patients, 22 (23%) had true cribriform‐negative (TN), 39 (40%) false‐negative (FN) and 36 (37%) true‐positive (TP) biopsies. Patients with FN biopsies had higher, although not statistically significant (P = 0.06), median PSA levels than patients with TP biopsies (12 versus 8 ng/ml). A PI‐RADS 5 lesion was present in nine of 16 (54%) FN and three of 11 (27%) TN biopsies (P = 0.05). Positive biopsy rate (P = 0.47), percentage Gleason pattern 4 (P = 0.55) and glomeruloid architecture (P = 1.0) were not different. Logistic regression identified PSA as an independent predictor (odds ratio = 3.5; 95% confidence interval = 1.2–9.4, P = 0.02) for cribriform architecture on radical prostatectomy, but not PI‐RADS score. The FN rate for large cribriform architecture at radical prostatectomy was 27%, which was lower than for any cribriform architecture (P = 0.01). During follow‐up (median 27 months), biochemical recurrence‐free survival of patients with TP biopsies was significantly shorter than that of those with FN biopsies (P = 0.03).ConclusionIn conclusion, 40% of grade group 2 prostate cancer biopsies were FN for cribriform architecture. These patients had higher PSA levels and more frequent PI‐RADS score 5 lesions than men with TN biopsies.
Highlights
Risk stratification and therapeutic decision-making in prostate cancer patients is affected by potential biopsy undersampling
The entire cohort consisted of 186 patients with matched biopsy and radical prostatectomy specimens
Logistic regression analysis on cribriform-negative biopsy patients showed that age [odds ratio (OR) = 1.1, 95% confidence interval (CI) = 1.0–1.3, P = 0.02] and prostate-specific antigen (PSA) (OR = 3.3, 95% CI = 1.2–9.1, P = 0.02) were independent predictive parameters for presence of cribriform architecture on radical prostatectomy in multivariable analysis, whereas PI-RADS
Summary
Risk stratification and therapeutic decision-making in prostate cancer patients is affected by potential biopsy undersampling. The Gleason score is one of the most important parameters for predicting disease outcome and guiding individual treatment. The optimal therapeutic strategy for men with Gleason score 3 + 4 = 7 (grade group 2) is still a matter of debate. While most of these patients will undergo active treatment, surveillance is increasingly being considered in this subgroup. Incorporation of additional clinicopathological and molecular parameters might be able to support optimal decision-making in this large prostate cancer subpopulation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
