[841] Isolated Single Core High Grade Prostatic Adenocarcinoma Is Associated with Increased Likelihood of Extraprostatic Extension, Seminal Vesicle Invasion, Positive Surgical Margins and Lymphovascular Invasion at Radical Prostatectomy

DA Fajardo, AW Partin, M Eisenberger, TL DeWeese, GJ Netto. Johns Hopkins University, Baltimore

Background: High grade PCa can rarely be diagnosed as a single focus involving a single biopsy core. It is of clinical interest to determine whether such limited high grade prostatic adenocarcinoma biopsy involvement carry the same aggressive implications in regard to risk of extraprostatic extension (EPE), seminal vesicle invasion (SVI) and likelihood of positive margin status (MG+) on radical prostatectomy (RRP).
Design: 92 PCa patients diagnosed with a standard ultrasound guided prostate needle biopsy procedure revealing only a single positive core and undergoing subsequent prostatectomy were retrieved from our surgical pathology archives (1999-2008). Cases were of four Gleason score (GS) groups: 3+3=6 (group1), 3+4=7 (group2), 4+3=7 (group3) and > 8 (group4). Bx data on pt age, pre-biopsy PSA (prePSA), GS, percentage of core involvement (Pos%), and total number of cores performed per case were collected. In addition, prostatectomy data on GS, extent of RRP involvement by PCa (RRPext), EPE, margin status, SVI, lymphovascular invasion (LVI), and lymph node metastasis (LN) were gathered on all cases.
Results: No statistically significant difference was observed among the four biopsy groups in: Total number of cores obtained, prePSA or Pos% (p:NS). A significantly higher rate of EPE was observed in group 4 compared to groups 1-3 (50.0%, 4.3%, 8% and 30% respectively; p<0.0006). Likewise, a significantly higher incidence of positive MG status (p<0.03), SVI (p<0.003), and LVI (p<0.008) was also observed in group 4 compared to the remaining groups. Furthermore, when cases in group 4 were stratified, according to their %Pos involvement of their single positive core using 50% as a cutoff, the incidence of EPE was higher in those with PCa involving > 50% of one core compared to cases with cancer involving < 50% (p<0.0001). The latter cases in turn had a higher incidence of EPE than the groups of cases with Conclusions: Isolated single biopsy core GS >8 prostatic adenocarcinoma is associated with a higher incidence of adverse RRP findings (EPE, SVI, LVI, and positive margins) when compared to cases with a single biopsy core containing PCa with GS<7. Cases with GS>8 involving less than 50% of a single core are still more likely to have EPE on RRP compared to those with a single GS <7 core cases.
Category: Genitourinary (including renal tumors)

Tuesday, March 23, 2010 1:00 PM

Poster Session IV # 109, Tuesday Afternoon

 

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