Extraprostatic extension of prostatic adenocarcinoma on needle core biopsy: report of 72 cases with clinical follow‐up

Abstract

Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To describe the histological findings and prognosis that are associated with extraprostatic extension (EPE) on needle core biopsy of prostatic adenocarcinoma. PATIENTS AND METHODS We retrieved 99 cases of prostatic adenocarcinoma with EPE at initial diagnosis on biopsy from the consultation files of one of the authors between 1997 and 2009. The 72 cases that had available clinical follow‐up data formed the basis of this study. RESULTS The mean (range) age of the patients was 64 (48–87) years, the median (mean, range) serum prostatic specific antigen level was 7.8 (64.8, 0.3–1505) ng/mL, and 60 of the patients (83%) had abnormalities on a digital rectal examination. The mean (range) number of malignant cores was 7.7 (1–23); the mean percentage of carcinoma in each core was 69.6%, and that in the core(s) with EPE was 76.8%. The mean Gleason score in the core(s) with EPE was 8, with a mean highest Gleason score per case of 8.4. Perineural invasion was detected in 54 cases (75%). Ten of 11 patients treated surgically had EPE on the radical prostatectomy (RP) specimen; also six had positive resection margins, five showed invasion into the seminal vesicles and one had lymph node metastasis. The Gleason scores in nine of the RP specimens did not differ from the highest grade found in the associated biopsies (score 9 in three, 8 in two, 7 in four); in one case it increased (from score 6 to 8) and in one it decreased (from score 9 to 8). Patients were followed for a mean (median, range) of 2.9 (2, 0.1–9) years, with metastases identified in 29 (40%); 10 (14%) died from the disease. CONCLUSION EPE on needle core biopsy of the prostate is strongly associated with extensive, high‐grade prostatic adenocarcinoma, such that its usefulness as an isolated prognostic factor is relatively limited.

Clinical Findings and Treatment Outcomes in Patients with Extraprostatic Extension Identified on Prostate Biopsy

“…The present study adds to the literature, and our data corroborate the prior study from JHU in which EPE on biopsy was similarly strongly associated with extensive, high-grade disease 2 . Results were concordant: most common Gleason score in cores with EPE 9 (MSKCC) vs. 8 (JHU); % cancer in biopsy cores 86% (median) vs. 70% (mean); concomitant perineural invasion 62% vs. 75%; 3-year risk of metastasis 32% vs. 40%; and outcomes after RP were similar: EPE (96% vs. 91%); positive margins (58% vs. 55%); SVI (52% vs. 45%) and LNI (46% vs. 10%).…”

“…EPE can manifest focally throughout the tissue, that is, only a few neoplastic glands are seen outside the prostate, or become non-focal with more glands 1 . Although most commonly detected in the radical prostatectomy (RP) specimen, EPE can also be found on preoperative Magnetic Resonance Imaging (MRI) and on prostate biopsy 2 .…”

“…To the best of our knowledge, there is only one publication in the literature reporting outcomes of patients with EPE on prostate biopsy. In that study, conducted at Johns Hopkins University (JHU), Miller et al examined 51,891 biopsies performed between 1997 and 2009 and reported a prevalence of EPE of only 0.19% 2 . Because of its rare occurrence, the clinical significance of this finding is not well understood.…”

Clinical Significance of Perineural Invasion in Prostate Needle Biopsy in Patients Diagnosed with Extraprostatic Extension and Seminal Vesicle Invasion after Radical Prostatectomy

“…Bu yüzden prostat biyopsi patolojisindeki PNİ bulgusunun ekstraprostatik yayılımda önemli bir bulgu olabileceği saptanmıştır (15). Yapılan çalışmalarda prostat biyopsisindeki PNİ pozitifliği ile ekstraprostatik yayılım, cerrahi sınır ve lenf nodu pozitifliği araştırılmış ve anlamlı sonuçlar saptanmıştır (7,8,9 …”

“…Prostat biyopsilerinde prostat kanser hücrelerinin sinir demeti boyunca yayılımını gösteren perinöral invazyon (PNİ) bulgusu biyopsi patolojilerinde rutin olarak raporlanmaktadır (6). PNİ varlığının ekstraprostatik yayılım ve cerrahi sınır pozitifliği ile ilişkili olduğu bazı çalışmalarda gösterilmiştir (7,8,9). Bu çalışmada RRP materyalinde pT3 prostat kanseri saptanan hastaların prostat biyopsisindeki PNİ bulgularının ekstraprostatik yayılımın derecesi ve seminal vezikül invazyonu ile olan ilişkisini değerlendirmeyi amaçladık.…”