Clinical and oncologic findings of extraprostatic extension on needle biopsy in de novo metastatic prostate cancer / 亚洲男科学杂志(英文版)

This study aimed to explore the clinical and oncologic findings in patients with de novo metastatic prostate cancer (mPCa) and extraprostatic extension (EPE) on biopsy. We retrospectively evaluated data on 630 patients with de novo mPCa between January 2009 and December 2017 in the West China Hospital (Chengdu, China), including evaluating the relationships between EPE and other variables and the association of EPE with survival outcomes by the Chi-square test, Kaplan-Meier curves, and the Cox proportional-hazards model. EPE was found in 70/630 patients, making a prevalence of 11.1%. The presence of EPE on biopsy was associated with higher Gleason scores and higher incidence of neuroendocrine differentiation (NED), intraductal carcinoma of the prostate (IDC-P), and perineural invasion (PNI). Compared with those without EPE, patients with EPE had shorter castration-resistant prostate cancer-free survival (CFS; median: 14.1 vs 17.1 months, P = 0.015) and overall survival (OS; median: 43.7 vs 68.3 months, P = 0.032). According to multivariate analysis, EPE was not an independent predictor for survival. Subgroup analyses demonstrated that patients with favorable characteristics, including negative NED or IDC-P status, Eastern Cooperative Oncology Group (ECOG) score <2, and prostate-specific antigen (PSA) <50 ng ml-1, had worse prognoses if EPE was detected. In patients with PSA <50 ng ml-1, EPE was a negative independent predictor for OS (hazard ratio [HR]: 4.239, 95% confidence interval [CI]: 1.218-14.756, P = 0.023). EPE was strongly associated with other aggressive clinicopathological features and poorer CFS and OS. These data suggest that EPE may be an indicator of poor prognosis, particularly in patients, otherwise considered likely to have favorable survival outcomes.

The value of prostate-specific antigen density in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer / 中华泌尿外科杂志

Objective To evaluate the role of PSA density with prostate volume determined by MR images in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer.Method A total of 71 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 2009 to December 2013 were included in the study.MRI PSAD,preoperative total serum PSA (tPSA),free PSA/total PSA (fPSA/tPSA),biopsy Gleason score,prostate volume,age,body mass index in patients with extraprostatic extension were compared with those in patients with organ-confined disease.The receiver operating characteristic (ROC) curve was used to analyze the performance of each of the above parameters to predict the extraprostatic extension.Multivariate logistic regression analysis was used to select the independent influencing factors for extraprostatic extension.Results Pathologic examination revealed 32 patients were positive for extraprostatic extension and 39 paticnts had organ-confined disease.MRI PSAD(P ＜ 0.001),tPSA (P ＜ 0.00l) and biopsy Gleason score levels (P =0.006) were higher in patients with extraprostatic extension than that in patients with organ-confined disease,and prostate volume was lower(P =0.009).MRI PSAD showed the largest area under ROC curve (AUC) among those parameter(AUC =0.852,P ＜ 0.001),and tPSA was the second (AUC =0.764).Multivariate logistic regression analyses showed that MRI PSAD was an independent predictor of extraprostatic extension.Conclusions MRI PSAD was better than tPSA in predicting pathological stage of extraprostatic extension.The value of PSAD should not be ignored in the prediction of pathological stage.

Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy

PURPOSE: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal) and in more than 1 quadrant or section (Group 2, diffuse); and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal) and in more than 2 quadrants or sections (Group 2, diffuse). The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS: Extraprostatic extension was found in 129/360 (35.8%) patients, 39/129 (30.2%) in Group 1 and 90/129 (69.8%) in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2) had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4%) patients, 81/160 (50.6%) patients in Group 1 and 79/160 (49.4%) patients in Group 2. Patients with diffuse positive surgical margins (Group 2) had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant predictors of shorter time to biochemical progression following radical prostatectomy.

A Study on the Incidence and Preoperative Predicting Factors of Extraprostatic Extension in T1c Prostate Cancers / 대한비뇨기과학회지

PURPOSE: To evaluate the incidence and identify the predicting factors of extraprostatic extension(EPE) in T1c prostate cancers. MATERIALS AND METHODS: Of 267 consecutive men who underwent radical retropubic prostatectomy(RRP) as initial treatment for prostate cancers, 131(49.1%) presented with a clinical stage T1c disease. Clinicopathological data were collected, and factors related to biopsy collected; i.e. the number of positive cores(No.(+) core); the percentage of positive cores(%(+) core); the maximal tumor length(Max. mm cancer); the sum of tumor length (Total mm cancer); the maximal ratio of tumor/core length(Max. % mm cancer) and the mean ratio of tumor/core length(Mean % mm cancer). A logistical regression analysis was performed after dividing the cases into organ-confined(OC) and EPE. RESULTS: Of the T1c tumors, 107(81.7%) and 24(18.3%) were found to be OC and to have EPE after RRP, respectively. The preoperative factors that showed a significant difference between the two groups(OC vs. EPE) were %free prostate-specific antigen(17.7 vs. 11.1%), prostate volume(43.5 vs. 34.6ml), Gleason score(6.4 vs. 6.8), %(+) core(17.9 vs. 27%), Max. mm cancer(3.5 vs. 6.7mm) and Max. % mm cancer(24.0 vs. 41.6%). Of these factors, those significantly predicting EPE in the receiver operator characteristics curve were: the Gleason score, %(+) core, Max. mm cancer and Max. % mm cancer. Of these, only the %(+) core and Max. mm cancer were significant in predicting EPE in the multivariate logistical regression. When the cutoff of %(+) core was 19%, the risk of EPE increased 2.3 times, and when the cutoff of Max. mm cancer was 5mm the risk increased 3.6 times. CONCLUSIONS: Max. mm cancer and %(+) core during a biopsy are preoperative factors that predict the EPE of a clinical stage T1c disease, and should be considered for modifying the surgical technique and in establishing treatment plans.

The Usefulness of Endo-rectal Coil MRI in the Staging of Clinically Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the ability of endo-rectal coil MRI (ER-MRI) to predict the local pathological stage of prostate cancer prior to radical prostatectomy and compared the results with those of transrectal ultrasonography (TRUS). MATERIALS AND METHODS: ER-MRI using high field magnets (1.5 Tesla) were performed in 22 patients (mean age 62.8 years, range 51-73) with clinically localized prostate cancer before radical prostatectomy. Of the 22 patients, 17 patients were also assessed by TRUS. The results of the imaging techniques were compared with the post-operative histopathological findings. As one patient with pelvic lymph node metastasis, which was detected on frozen-section examination during surgery, was spared radical prostatectomy, the final evaluation included 21 patients. RESULTS: DSeven of the 21 patients (33%) were found to have extraprostatic extension (EPE), and 5 had seminal vesicle invasion (SVI). The sensitivity and specificity for diagnosing EPE using ER-MRI were 62.5% and 84.6%, respectively, and 16.7% and 100% with TRUS. The sensitivity and specificity for diagnosing SVI were 80.0% and 93.8%, respectively with ER-MRI, and 0% and 92.3% with TRUS. The accuracy of predicting SVI was 90.5% with ER-MRI compared to 70.6% with TRUS. CONCLUSIONS: ER-MRI was significantly better than TRUS for determining the local extent of prostatic cancer and for prediction of SVI in the preoperative staging of clinically localized prostate cancer.