Prediction of pathological and oncological outcomes based on extended prostate biopsy results in patients with prostate cancer receiving radical prostatectomy: a single institution study

Fumio Ishizaki,Noboru Hara,Makoto Kawaguchi,Akira Tadokoro,Itsuhiro Takizawa,Tsutomu Nishiyama,Rudolf Hohenfellner,Hiroshi Koike,Kota Takahashi

doi:10.1186/1746-1596-7-68

Fumio Ishizaki, Noboru Hara + Show 7 more

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https://doi.org/10.1186/1746-1596-7-68

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Abstract

BackgroundThe prediction of pathological outcomes prior to surgery remains a challenging problem for the appropriate surgical indication of prostate cancer. This study was performed to identify preoperative values predictive of pathological and oncological outcomes based on standardized extended prostate biopsies with core histological results diagrammed/mapped in patients receiving radical prostatectomy for prostate cancer clinically diagnosed as localized or locally advanced disease.MethodsIn 124 patients with clinically localized or locally advanced prostate cancer (cT1c–cT3a) without prior treatment, pathological outcomes on the surgical specimen including seminal vesicle involvement (SVI), positive surgical margin (PSM), and perineural invasion (PNI) were studied in comparison with clinical parameters based on the results of 14-core prostate biopsies comprising sextant, laterally-directed sextant, and bilateral transition zone (TZ) sampling.ResultsConcerning the association of pathological outcomes with oncological outcomes, patients with PSM and PNI on surgical specimens had poorer biochemical-progression-free survival than those without PSM (logrank p = 0.002) and PNI (p = 0.003); it was also poorer concerning SVI, although the difference was not significant (p = 0.120). Concerning the impact of clinical parameters on these pathological outcomes, positive TZ and multiple positive biopsy cores in the prostatic middle were independent values predictive of SVI with multivariate analyses (p = 0.020 and p = 0.025, respectively); both positive TZ and multiple positive prostatic middle biopsies were associated with larger tumor volume (p < 0.001 in both). The percentage of positive biopsy cores (%positive cores) and biopsy Gleason score were independent values predictive of PSM (p = 0.001) and PNI (p = 0.001), respectively. Multiple positive cores in the prostatic base were associated with proximal/bladder-side PSM (p < 0.001), and also linked to poorer biochemical-progression-free survival (p = 0.004). Clinical T stage had no association with these pathological outcomes.Conclusions%positive cores and Gleason score in extended biopsies were independent values predictive of PSM and PNI in prostate cancer clinically diagnosed as localized or locally advanced disease, respectively, which were associated with poorer oncological outcomes. When diagramming biopsy-core results, extended biopsy may provide additional information for predicting oncological and pathological outcomes including SVI in patients clinically diagnosed as having localized or locally advanced disease.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8790262771042628

Highlights

The prediction of pathological outcomes prior to surgery remains a challenging problem for the appropriate surgical indication of prostate cancer
Since the advent of the preoperative staging table/nomogram, the clinical staging of localized or locally advanced prostate cancer has been revolutionized both for radical surgery and radiotherapy [1,2,3]. These predictive scales are used for the calculation of possible oncological outcomes or probability of extraprostatic extension in the pathological stage, for example, seminal vesicle involvement (SVI), by combining clinical parameters/variables such as serum variable prostate-specific antigen levels, digital rectal examination findings, Gleason score at prostate biopsy, and percentage of positive biopsy cores (%positive cores) [1,2,3]
Positive surgical margin (PSM) and perineural invasion (PNI) have been suggested to have a prognostic value [6,8], but clinical parameters predictive of positive surgical margin (PSM) remain controversial and studies on PNI are limited. The prediction of these pathological outcomes prior to surgery is significant in clinical practice, but there has been no study examining which clinical parameters reflect each of SVI, PSM, and PNI; such analyses may confirm the feasibility of staging nomograms based on pathological approaches

Summary

Introduction

The prediction of pathological outcomes prior to surgery remains a challenging problem for the appropriate surgical indication of prostate cancer. Positive surgical margin (PSM) and perineural invasion (PNI) have been suggested to have a prognostic value [6,8], but clinical parameters predictive of PSM remain controversial and studies on PNI are limited. The prediction of these pathological outcomes prior to surgery is significant in clinical practice, but there has been no study examining which clinical parameters reflect each of SVI, PSM, and PNI; such analyses may confirm the feasibility of staging nomograms based on pathological approaches

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