Frequency and Clinico-Pathologic Features of Dominant Anterior Prostatic Carcinomas
Justin Mygatt, Inger Rosner, Joel Barton, Isabell Sesterhenn, Yongmei Chen, Jennifer Cullen, Shiv Srivastava, David G McLeod, Stephen Brassell. USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethesda, MD; Joint Pathology Center, Silver Spring, MD; Center for Prostate Disease Research, Rockville, MD
Background: Prostate cancer screening and extended template, laterally directed biopsies led to early detection and stage migration of most prostate cancer patients with tumors located in the posterior zone. It is unknown how these interventions affect anterior predominant tumors. Our goal was to determine the clinico-pathologic features including ERG oncoprotein expression and outcomes of tumors in the anterior zone as compared to conventional locations.
Design: A retrospective review of 1528 radical prostatectomy specimens processed by whole mount and close step sectioning between 1989 and 2011 was completed. The ERG oncoprotein expression was evaluated by immunohistochemistry in representative whole mount prostate specimens using a highly specific ERG monoclonal antibody (9FY). Tumors were classified as ERG positive or negative. Cox proportional hazard models were used to compare clinic-pathologic features across tumor types and Kaplan-Meier analysis to compare biochemical recurrence-free and overall survival.
Results: Tumors occurred predominantly in the anterior location in 155 (10.1%) of specimens. There was no difference between mean age, BMI, racial distribution, family history, number of prior biopsies, biopsy Gleason sum, or pathologic stage in the two groups. Tumor volume did differ with anterior tumors having a mean 8.3cc vs. 5.6cc (p<0.0001) size. As expected, less patients had clinically palpable disease (cT2 or greater) in the anterior tumor group, 28.8% vs. 40.7% (p=0.0150). The anterior tumor group had lower pathologic Gleason sum (p=0.0133) but higher incidence of positive margins (p=0.0008). There were no differences in biochemical recurrence-free or overall survival. Only 11 (8%) of 138 anterior tumors expressed the ERG oncoprotein which was significantly lower than 50-65% overall ERG frequency.
Conclusions: Despite the potential for adverse pathologic features in anterior based disease, there appears to be no demographic predilection, notable delay in diagnosis, or significant difference in survival outcomes. The reason for the very low ERG oncoprotein detection in predominantly anterior tumors is unknown.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 157, Monday Afternoon