MP34-09 PREVALENCE AND PROGNOSTIC IMPACT OF PROSTATE CANCER HISTOLOGICAL VARIANTS AT RADICAL PROSTATECTOMY: A LONG-TERM, SINGLE CENTER ANALYSIS

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2018MP34-09 PREVALENCE AND PROGNOSTIC IMPACT OF PROSTATE CANCER HISTOLOGICAL VARIANTS AT RADICAL PROSTATECTOMY: A LONG-TERM, SINGLE CENTER ANALYSIS Carlo Andrea Bravi, Giorgio Gandaglia, Nicola Fossati, Roberta Lucianò, Emanuele Zaffuto, Vincenzo Scattoni, Andrea Gallina, Roberto Bertini, Massimo Freschi, Shahrokh F. Shariat, Vincenzo Mirone, Pierre I. Karakiewicz, Rodolfo Montironi, Claudio Doglioni, Francesco Montorsi, and Alberto Briganti Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Roberta LucianòRoberta Lucianò More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Vincenzo ScattoniVincenzo Scattoni More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Rodolfo MontironiRodolfo Montironi More articles by this author , Claudio DoglioniClaudio Doglioni More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1101AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although variant histological subtypes in prostate cancer (PCa) are rare, recent studies reported conflicting results regarding their aggressiveness. We sought to assess the incidence of variant histological subtypes in patients treated with radical prostatectomy (RP). We then focused on the impact of variant histology on disease features and outcomes METHODS Overall, 8,723 PCa patients treated with RP ± ePLND between 1997 and 2017 at a single center were identified. All prostatectomy specimens were evaluated by four high- volume uro-pathologists. Individuals with variant histologic subtypes at final pathology (namely, ductal and mucinous adenocarcinoma) were identified. The Mann-Whitney and chi-square tests assessed differences in medians and proportions between acinar adenocarcinoma vs. variant histologic subtype. We focused on age, preoperative PSA, clinical stage, pathologic stage, positive surgical margins (PSM) and lymph node invasion (LNI). Biochemical recurrence (BCR) was defined as two consecutive PSA ≥0.2 ng/ml. Clinical recurrence (CR) was defined as positive imaging during follow-up. Kaplan-Meier analyses assessed time to BCR, CR and cancer-specific mortality (CSM) according to the histologic subtype RESULTS Overall, 8,659 (99.3%), 44 (0.5%) and 20 (0.2%) patients had acinar adenocarcinoma, ductal adenocarcinoma and mucinous carcinoma of the prostate. Median age and preoperative PSA were 65.3 vs 66.8 vs 63.1 years and 6.7 vs 7.7 vs 8.9 ng/ml for acinar, ductal and mucous carcinoma (all P≥0.2). Clinical stage was T3 in 733 (8.4%), 6 (13.6%) and 3 (15%) in acinar, ductal and mucinous carcinoma (P=0.1). Overall, 1,267 (14.6%), 16 (36.4%) and 7 (35%) acinar, ductal and mucinous carcinoma had pT3b/4 disease (P<0.001). The PSM and LNI rates were 24.8 vs 34.1 vs 35% and 11.4 vs 27.3 vs 35% in acinar vs ductal vs mucinous carcinoma (all P<0.001). Median follow-up for survivors was 66 months. When patients were stratified according to the histologic subtype, the 10-year BCR-, CR-, and CSM-free survival rates were 67.2 vs 31.7 vs 58.9%, 91.3 vs 70.9 vs 99% and 96.4 vs 79.5 vs 99% for acinar vs ductal vs mucous carcinoma (all P<0.001) CONCLUSIONS Although baseline characteristics of patients with variant histologic subtypes do not differ compared to acinar adenocarcinoma, men with ductal or mucinous carcinoma have a higher rate of pT3b/4, PSM and LNI. Only the presence of ductal adenocarcinoma was associated with an increased risk of CR and CSM. These patients should be considered for more aggressive postoperative therapies © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e441 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Carlo Andrea Bravi More articles by this author Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Roberta Lucianò More articles by this author Emanuele Zaffuto More articles by this author Vincenzo Scattoni More articles by this author Andrea Gallina More articles by this author Roberto Bertini More articles by this author Massimo Freschi More articles by this author Shahrokh F. Shariat More articles by this author Vincenzo Mirone More articles by this author Pierre I. Karakiewicz More articles by this author Rodolfo Montironi More articles by this author Claudio Doglioni More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...