Abstract
Simple SummaryDespite the strong association of the aggressive intraductal carcinoma of the prostate (IDC-P) with an increased risk of biochemical recurrence (BCR), around 40% of men remain BCR-free five years post-surgery. In this retrospective study, we aimed to evaluate the prognostic value of several morphological criteria of IDC-P using BCR as the endpoint. In multivariate analysis (validation cohort, n = 69), the presence of cells with irregular nuclear contours (CINC) or blood vessels was independently associated with an increased risk of BCR (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.09–4.96, p = 0.029). Furthermore, when combining the criteria, the presence of any CINC, blood vessels, high mitotic score, or comedonecrosis showed a stronger association with BCR (HR 2.74, 95% CI 1.21–6.19, p = 0.015). Provided that our findings are validated in larger cohorts, evaluation of morphologic features of IDC-P could serve as a risk stratification tool for patients with IDC-P.Intraductal carcinoma of the prostate (IDC-P) is an aggressive subtype of prostate cancer strongly associated with an increased risk of biochemical recurrence (BCR). However, approximately 40% of men with IDC-P remain BCR-free five years after radical prostatectomy. In this retrospective multicenter study, we aimed to identify histologic criteria associated with BCR for IDC-P lesions. A total of 108 first-line radical prostatectomy specimens were reviewed. In our test cohort (n = 39), presence of larger duct size (>573 µm in diameter), cells with irregular nuclear contours (CINC) (≥5 CINC in two distinct high-power fields), high mitotic score (>1.81 mitoses/mm2), blood vessels, and comedonecrosis were associated with early BCR (<18 months) (p < 0.05). In our validation cohort (n = 69), the presence of CINC or blood vessels was independently associated with an increased risk of BCR (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.09–4.96, p = 0.029). When combining the criteria, the presence of any CINC, blood vessels, high mitotic score, or comedonecrosis showed a stronger association with BCR (HR 2.74, 95% CI 1.21–6.19, p = 0.015). Our results suggest that IDC-P can be classified as low versus high-risk of BCR. The defined morphologic criteria can be easily assessed and should be integrated for clinical application following validation in larger cohorts.
Highlights
Intraductal carcinoma of the prostate (IDC-P) is accepted as a biologically distinct entity of prostate cancer (PCa) [1]. Since it was first described as a “ductal spread in prostatic carcinoma” by Kobi et al in 1985 [2], multiple studies clarified the concept of IDC-P as a lumen-spanning spread and growth of neoplastic epithelial cells in ducts retaining basal cells [3,4,5,6] and almost always found adjacent to invasive, mostly aggressive, PCa [7,8,9,10,11,12,13]
The biochemical recurrence (BCR) rate was higher in Center 2, with BCR developing in 59% of patients from Center 2 compared to 25% of patients from Center 1 (p = 0.035)
We focused on the morphological diversity between IDC-P lesions and found five morphologic criteria associated with early BCR in our test cohort: the presence of larger duct size, high mitotic score, comedonecrosis, vessels, or cells with irregular nuclear contours (CINC)
Summary
Intraductal carcinoma of the prostate (IDC-P) is accepted as a biologically distinct entity of prostate cancer (PCa) [1]. Since it was first described as a “ductal spread in prostatic carcinoma” by Kobi et al in 1985 [2], multiple studies clarified the concept of IDC-P as a lumen-spanning spread and growth of neoplastic epithelial cells in ducts retaining basal cells [3,4,5,6] and almost always found adjacent to invasive, mostly aggressive, PCa [7,8,9,10,11,12,13]. The most frequently used criteria, established by Guo and Epstein, are highly specific and designed to identify prostates with IDC-P, but without associated invasive carcinoma [9]
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