Extraprostatic Extension of Prostatic Adenocarcinoma on Needle Core Biopsy: Report of 72 Cases with Clinical Follow-Up
JS Miller, Y Chen, BD Robinson, F Brimo, JI Epstein. Johns Hopkins Hospital, Baltimore
Background: Extraprostatic extension (EPE) of prostatic adenocarcinoma is rarely found on needle core biopsy and has not been formally addressed in the literature.
Design: We retrieved 99 cases of prostatic adenocarcinoma with EPE at initial diagnosis on biopsy from the consult 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: Mean patient age was 64 years (range 48 to 87), median serum prostatic specific antigen (PSA) was 7.8 ng/mL (mean 64.8, range 0.3 to 1505), and 60 of the patients (83%) had an abnormal digital rectal examination (DRE). The average number of malignant cores was 7.7 (range 1 to 23); average percent of carcinoma in each core was 69.6%; average percent of carcinoma in the core(s) demonstrating EPE was 76.8%. The average Gleason score in the core(s) demonstrating EPE was 8; average highest Gleason score per case was 8.4. Perineural invasion was demonstrated in 54 cases (75%). Ten out of 11 cases treated surgically demonstrated EPE on the radical prostatectomy; additionally, 6 had positive resection margins, 5 showed invasion into the seminal vesicles and 1 demonstrated lymph node metastasis. The Gleason scores in 9 of the prostatectomies did not differ from the highest grade found in the associated biopsies (score 9 [n=3], score 8 [n=2], score 7 [n=4]); in one case it increased (from score 6 to 8) and in one case it decreased (from score 9 to 8). Patients were followed for an average of 2.9 years (median 2, range 0.1 to 9) with metastases identified in 29 (40%); 10 (14%) died from the disease.
Conclusions: 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.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 106, Tuesday Afternoon