[862] 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)
LN+	31.1	51.4/45.7	65.7	51.4	22.8
LN-	15.0	85.4/14.6	25.6	9.8	3.7

Conclusions: Within GS7 prostatic carcinoma, there are significant differences in cases with LN+ vs. LN- in ethnicity, preoperative PSA, tumor volume, stage, LVI, intraductal spread, satellite tumor foci, nuclear enlargement and size of macronucleoli. These variables may be worthwhile to assess as prognostic markers in GS7 disease on biopsy (ie. IDC, cytology) or at RP (all variables) even in men with LN-.
Category: Genitourinary (including renal tumors)

Monday, February 28, 2011 1:00 PM

Poster Session II # 112, Monday Afternoon