Pathological Features of Contemporary Radical Prostatectomy Specimens for Prostate Cancer.
Cristina Magi-Galluzzi, Sara M Falzarano, Karen Streator Smith, Eric A Klein, Ming Zhou. Cleveland Clinic
Background: Prostate cancer (PCA) disease has changed substantially over the last 20 years due to the introduction of prostate-specific antigen (PSA) blood test in PCA screening. The present study was carried out to analyze the pathological features of contemporary PCA in radical prostatectomy specimens (RP) and compare them with RP from 1987-2004.
Design: We analyzed the pathological features of 1109 consecutive RP performed for clinically localized prostate cancer (PCA) at our institution between 2005 and 2010 (Group1). Pathologic features were compared with a cohort of 471 patients who underwent RP at the same institution between 1987 and 2004 (Group 2). All cases were reviewed by a single genitourinary pathologist, mapped, staged and graded according to the 2005 ISUP consensus conference on Gleason grading. For purposes of analysis, GS was subdivided in three categories: GS ≤6, GS=7 and GS≥8.
Results: Patients mean age was 59 (range 39-81) and 62 years (range 42-77) for Group 1 and 2, respectively. Pathological characteristics for the two groups are reported in table 1. Number of patients who underwent lymph node dissection, lymph node metastases (LN+), margin of resection (MOR) status, microscopic bladder neck (BN) involvement and lymphovascular invasion (LVI) were significantly different between groups (Table 1). PCA was mostly bilateral (88% and 83%). Tumor volume distribution in Group 1 was as such: low (<0.5 cc) in 19%, medium (0.5-2.0 cc) in 50%, and extensive (>2.0cc) in 31% of cases. A single focus PCA was detected in 13%, 2 distinct PCA in 17%, multifocal PCA in 62% of cases. In 4% and 3% of cases, respectively, PCA involved half of or the entire prostate.
Conclusions: There is a significant shift towards more favorable pathological parameters in RP specimens in contemporary series (2005-2010)compared to 1987-2004. This shift may result from a change in patient selection or PCA biology. PCA continues to be predominantly a bilateral and multifocal disease, with extensive volume in approximately 1/3 of cases.
|2005-2010||1987-2004||p (Chi Square)|
|Tertiary pattern 5||6%||11%||0.001|