Gleason Score (GS) 7 Prostate Cancer with Lymph Node Metastases (LN+): Findings at Radical Prostatectomy (RP).
Oleksandr N Kryvenko, Nilesh S Gupta, Nilam Virani, Zhaoli Lane, Jonathan I Epstein. Henry Ford Hospital, Detroit; Jefferson Medical College, Philadelphia; Johns Hopkins University, Baltimore
Background: Prostate cancers with LN+ are relatively rare in contemporary practice and typically seen with GS8-10 disease. Little is known about the morphology of GS7 prostate cancer with LN+.
Design: RPs with GS7 LN+ without prior therapy from 2000 to 2010 composed the study group. A control group (at least two times in number) without LN metastases (LN-) was Gleason and stage-matched. Remote tumor foci were classified as satellites when they had the same morphology as the dominant nodule; otherwise they were interpreted as multifocal.
Results: The study group was composed of GS347 (n=11), GS437 (n=14), GS347 with tertiary 5 (n=2), and GS437 with tertiary 5 (n=8). No difference in age was seen between study and control. A higher proportion of the LN+ patients were black compared to the percentage of LN-, 42.9% vs. 13.4%, respectively (p=0.0004). Mean preoperative PSA was higher in those with LN+ (13.8) vs. those with LN- (7.9) (p=0.03). The percentage of positive biopsy cores almost reached statistical significance with a mean of 55.4% for LN+ compared to 45.3% for LN- (p=0.055). At RP, there were no differences seen in prostate weight, focal vs. non-focal EPE, or Gleason 4 pattern (poorly formed glands vs. fused vs. cribriform vs. glomeruloid). Graded subjectively as 1-3, nuclei (p=0.007) and nucleoli (p=0.0005) were larger with LN+ vs. LN-, with no difference in nuclear pleomorphism or nucleoli distribution. Other morphologic findings are listed in table (LVI = lymphovascular invasion; IDC = intraductal carcinoma).
|Tumor Vol., % (<0.0001)||pT3a/pT3b, % (0.0006)||LVI, % (<0.0001)||IDC, % (<0.0001)||Satellites, % (0.001)|