Recent advances in prostate cancer pathology: Gleason grading and beyond

Shah, Rajal B.; Zhou, Ming

doi:10.1111/pin.12398

Cited by 36 publications

(35 citation statements)

References 66 publications

(131 reference statements)

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“…We show that IDC‐P, cribriform Gleason pattern 4, and stromogenic PCa are significantly associated with PTEN loss. In contemporary literature, these three histological parameters have been independently validated as important unfavorable pathological features of PCa associated with a variety of poor clinical outcomes across different cohorts …”

Section: Discussionsupporting

confidence: 91%

PTEN loss in prostatic adenocarcinoma correlates with specific adverse histologic features (intraductal carcinoma, cribriform Gleason pattern 4 and stromogenic carcinoma)

Shah

Shore

Yoon³

et al. 2019

The Prostate

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Background The loss of PTEN tumor suppressor gene is one of the most common somatic genetic aberrations in prostate cancer (PCa) and is frequently associated with high‐risk disease. Deletion or mutation of at least one PTEN allele has been reported to occur in 20% to 40% of localized PCa and up to 60% of metastases. The goal of this study was to determine if somatic alteration detected by PTEN immunohistochemical loss of expression is associated with specific histologic features. Methods Two hundred sixty prostate core needle biopsies with PCa were assessed for PTEN loss using an analytically validated immunohistochemical assay. Blinded to PTEN status, each tumor was assessed for the Grade Group (GG) and the presence or absence of nine epithelial features. Presence of stromogenic PCa was also assessed and defined as grade 3 reactive tumor stroma as previously described: the presence of carcinoma associated stromal response with epithelial to stroma ratio of greater than 50% reactive stroma. Results Eight‐eight (34%) cases exhibited PTEN loss while 172 (66%) had intact PTEN. PTEN loss was significantly (P < 0.05) associated with increasing GG, poorly formed glands (74% of total cases with loss vs 49% of intact), and three well‐validated unfavorable pathological features: intraductal carcinoma of the prostate (IDC‐P) (69% of total cases with loss vs 12% of intact), cribriform Gleason pattern 4 (38% of total cases with loss vs 10% of intact) and stromogenic PCa (23% of total cases with loss vs 6% of intact). IDC‐P had the highest relative risk (4.993, 95% confidence interval, 3.451‐7.223, P < 0.001) for PTEN loss. At least one of these three unfavorable pathological features were present in 67% of PCa exhibiting PTEN loss, while only 11% of PCa exhibited PTEN loss when none of these three unfavorable pathological features were present. Conclusions PCa with PTEN loss demonstrates a strong correlation with known unfavorable histologic features, particularly IDC‐P. This is the first study showing the association of PTEN loss with stromogenic PCa.

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Section: Discussionsupporting

confidence: 91%

PTEN loss in prostatic adenocarcinoma correlates with specific adverse histologic features (intraductal carcinoma, cribriform Gleason pattern 4 and stromogenic carcinoma)

Shah

Shore

Yoon³

et al. 2019

The Prostate

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“…In addition, the precise distinction among highgrade PIN, atypical ductal hyperplasia, and IDC-P, even if immunohistochemical staining were performed. 34 Therefore, we performed neither the characterization nor quantification of IDC-P in this study.…”

Section: Discussionmentioning

confidence: 99%

The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance

et al. 2019

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Background Although the presence of intraductal carcinoma of the prostate (IDC‐P) influences biochemical failure in radical prostatectomy patients, no data are available regarding the impact of its integration into the classification grade group system. Thus, the aim of this study was to enhance the utility of the grade group system by integrating the presence of IDC‐P. Methods This study was a retrospective evaluation of 1019 patients with prostate cancer who underwent radical prostatectomy between 2005 and 2013 without neoadjuvant or adjuvant therapy. The data on age, prostate‐specific antigen (PSA) level at diagnosis, pathological T stage (pT), presence of Gleason pattern 5 (GP5), presence of IDC‐P, and surgical margin status were analyzed to predict PSA recurrence after prostatectomy. Results The median patient age was 67 (range, 45‐80) years and the median initial PSA level was 6.8 (range, 0.4‐82) ng/mL. The median follow‐up period was 82 (range, 0.7‐148) months. IDC‐P was detected in 157 patients (15.4%). Among these patients, the increase in the positive rate of IDC‐P correlated with tumor upgrading. The grade groups (GGs) were as follows: GG1 without IDC‐P, 16.0% (n = 163); GG2 without IDC‐P, 46.1% (n = 470); GG3 without IDC‐P, 15.7% (n = 160); GG4 without IDC‐P, 2.6% (n = 27); GG5 without IDC‐P, 4.1% (n = 42); any GG with IDC‐P, 15.4% [n = 157; GG 2 (n = 29); GG3 (n = 60); GG4 (n = 13); GG5 (n = 55)]. Any grade Group with IDC‐P showed significantly worse prognosis than any other group without IDC‐P (P < 0.0001). In a multivariate analysis, integration of the IDC‐P into the Grade Groups, the PSA level at diagnosis, and the surgical margin status were significant prognostic predictors (P < 0.0001, < 0.0001 and < 0.0001, respectively). Conclusions Integrating the presence of IDC‐P into the grade group system will result in more accurate predictions of patient outcome.

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“…was asked and consensus was reached between the genitourinary pathologists. Gleason scores were assigned to all lesions as combinations of primary, secondary, and tertiary Gleason grade, as defined by the 2014 International Society of Urological Pathology Modified Gleason Grading System . If a Gleason grade pattern higher than the primary and secondary grade was present and visually accounted for less than 5% of the tumor volume, it was assigned as tertiary Gleason grade.…”

Section: Methodsmentioning

confidence: 99%

“…Gleason scores were assigned to all lesions as combinations of primary, secondary, and tertiary Gleason grade, as defined by the 2014 International Society of Urological Pathology Modified Gleason Grading System. 21,22 If a Gleason grade pattern higher than the primary and secondary grade was present and visually accounted for less than 5% of the tumor volume, it was assigned as tertiary Gleason grade. Only PCa lesions with a diameter > 5 mm or any Gleason Grade 4 were included in the final analyses and correlation with IMPROD bpMRI findings.…”

Section: Histopathological Analysismentioning

confidence: 99%

IMPROD biparametric MRI in men with a clinical suspicion of prostate cancer (IMPROD Trial): Sensitivity for prostate cancer detection in correlation with whole‐mount prostatectomy sections and implications for focal therapy

Merisaari

Jambor

Ettala

et al. 2019

Magnetic Resonance Imaging

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Background Prostate MRI is increasingly being used in men with a clinical suspicion of prostate cancer (PCa). However, development and validation of methods for focal therapy planning are still lagging. Purpose To evaluate the diagnostic accuracy on lesion, region‐of‐interest (ROI), and voxel level of IMPROD biparametric prostate MRI (bpMRI) for PCa detection in men with a clinical suspicion of PCa who subsequently underwent radical prostatectomy. Study Type Prospective single‐institution clinical trial (NCT01864135). Population Sixty‐four men who underwent radical prostatectomy after IMPROD bpMRI performed in prebiopsy settings. Field Strength/Sequence IMPROD bpMRI consisted of T2‐weighted imaging (T2w) and three separate diffusion‐weighted imaging acquisitions with an average acquisition time of 15 minutes. Assessment The diagnostic accuracy of prospectively reported manual cancer delineations and regions increased with 3D dilation were evaluated on the voxel level (volume of 1.17 mm3, 1 mm3, 125 mm3) as well as the 36 ROI level. Only PCa lesions with a diameter ≥ 5 mm or any Gleason Grade 4 were analyzed. All data and protocols are freely available at: http://petiv.utu.fi/improd Statistical Tests Sensitivity, specificity, accuracy. Results In total, 99 PCa lesions were identified. Forty (40%, 40/99) had a Gleason score (GS) of >3 + 4. Twenty‐eight PCa lesions (28%, 28/99) were missed by IMPROD bpMRI, three (7.5%, 3/40) with GS >3 + 4. 3D dilation of manual cancer delineations in all directions by ~10–12 mm (corresponding to the Hausdorff distance) was needed to achieve sensitivity approaching 100% on a voxel level. Data Conclusion IMPROD bpMRI had a high sensitivity on lesion level for PCa with GS >3 + 4. Increasing 3D lesion delineations by ~10–12 mm (corresponding to the Hausdorff distance) was needed to achieve high sensitivity on the voxel level. Such information may help in planning ablation therapies. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1641–1650.

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Recent advances in prostate cancer pathology: Gleason grading and beyond

Cited by 36 publications

References 66 publications

PTEN loss in prostatic adenocarcinoma correlates with specific adverse histologic features (intraductal carcinoma, cribriform Gleason pattern 4 and stromogenic carcinoma)

PTEN loss in prostatic adenocarcinoma correlates with specific adverse histologic features (intraductal carcinoma, cribriform Gleason pattern 4 and stromogenic carcinoma)

The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance

IMPROD biparametric MRI in men with a clinical suspicion of prostate cancer (IMPROD Trial): Sensitivity for prostate cancer detection in correlation with whole‐mount prostatectomy sections and implications for focal therapy

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