Extraprostatic Extension on Prostate Needle Biopsy: Uncommon Finding with Important Implications
Sara M Falzarano, Karen Streator Smith, Cristina Magi-Galluzzi. Cleveland Clinic, Cleveland, OH
Background: The presence of extraprostatic extension (EPE) in prostate cancer (PCA) is correlated with an increased risk for developing distant metastases and corresponds to a high pathologic stage (pT3a). Among men who undergo radical prostatectomy (RP), those with extraprostatic tumor growth have been shown to harbor up to 14 times the risk of PCA death than those without it.
Design: All patients diagnosed with EPE on prostate biopsy (PBx) performed at our institution between 2004 and 2012 were retrieved from the pathology electronic archives. PBx histological findings, patients treatment modality and clinical follow-up were collected in an IRB approved database.
Results: Of the 4291 patients who underwent PBx, 97 (∼2%) had EPE. For 95 (98%) patients the PBx with EPE was an initial (diagnostic) biopsy. Patients mean age was 69 years (range 38-92); median total number of PBx cores was 12. Gleason score (GS) was 6 in 3 (3%), 7 in 29 (30%), 8 in 17 (17%), 9 in 44 (45%) and 10 in 1 (1%) case. One tumor (1%) was a pure squamous cell carcinoma and 2 (2%) were not graded due to treatment effect. Median percentage of PBx core involvement was 95%; median number of positive cores was 10. Perineural and seminal vesicles invasion was present in 78% and 6% of cases, respectively. Treatment modality was available for 86 patients: 38 men received monotherapy (RP = 8, LHRH agonists = 13, seeds implant = 5, bicalutamide = 4, EBRT = 2, IMRT = 2, 5α-reductase inhibitors = 2, orchiectomy = 2); 20 LHRH agonists + bicalutamide followed by docetaxel in 4 cases, 15 radiation therapy (RT) + androgen deprivation therapy (ADT); 10 RP followed by ADT in 4 cases, RT in 4 cases and ADT+RT in 2 cases; 3 combined therapy (RT+cryotherapy, RT +chemotherapy, LHRH agonists + chemotherapy). Of 18 (19%) patients who underwent RP, GS was 7 in 4 (22%), 7 with tertiary 5 in 4 (22%), 8 in 2 (11%), 9 in 7 (39%), and unassigned in 1 (5%); stage was pT2 in 1, pT3a in 7 and pT3b in 10. Two (11%) patients had lymph node metastasis. FU was available in 91 pts (mean 22 months). Radiographic evidence of bone metastasis was present in 28 (31%) men (12 at diagnosis, 16 at 1-4 years after diagnosis). Seven (8%) patients died of disease and 7 of other causes.
Conclusions: EPE on PBx is exceedingly rare (∼2%) and frequently associated with high grade GS. Despite the fact that more than half of patients received multimodality therapy, a third had evidence of bone metastasis and 8% died of disease. Our findings confirm the high risk of distant metastases and PCA deaths associated with EPE and highlight the potential prognostic implications of EPE on initial PBx.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 2:30 PM
Proffered Papers: Section A, Monday Afternoon