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Cribriform morphology predicts upstaging after radical prostatectomy in patients with Gleason score 3 + 4 = 7 prostate cancer at transrectal ultrasound (TRUS)-guided needle biopsy

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Abstract

Selected patients with transrectal ultrasound (TRUS)-guided biopsies containing Gleason score 3 + 4 = 7 prostate cancer (PCa) may be considered candidates for active surveillance (AS). The purpose of this study was to determine if there are features that predict PCa upstaging and/or upgrading after radical prostatectomy (RP) in patients with Gleason score 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsies. We searched our institution’s database for patients with Gleason score 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsy who underwent subsequent RP between January 2010 and January 2015. Two blinded genitourinary pathologists independently reviewed and assessed the following on biopsies: (a) nuclear size, nucleolar size and distribution of macronucleoli of PCa, which were subjectively graded using a semi-quantitative scale from 1 to 3, and (b) PCa with cribriform morphology and the size of cribriform disease. Patient age, serum prostate-specific antigen (PSA) and PSA density (PSAD) were also recorded. The Gleason score and stage (presence or absence of organ-confined disease (OCD)) were retrieved from RP reports. Comparisons were performed between groups using the chi-square test and Spearman correlation. One hundred and four patients were identified to have met inclusion criteria. The mean age was 63 (±6.1) years. Mean PSA and PSAD at diagnosis were 7.5 (±4.2) and 0.25 (±0.15) ng/mL, respectively. Gleason scores were upgraded to greater than 3 + 4 = 7 in 26.9 % (28/104) of patients, and 44.2 % (46/104) of patients had no OCD after RP. There was no correlation between age, PSA, PSAD or percent of biopsies with Gleason pattern 4 for either Gleason score upgrading or absence of OCD at the time of RP (p > 0.05). Thirty patients had cribriform morphology on TRUS-guided biopsy of which 60 % (18/30) had no OCD at RP (p = 0.04) while 36.7 % (11/30) were upgraded to Gleason score ≥3 + 4 = 7 after RP (p = 0.15). There was no association between nuclear size, nucleolar size and/or distribution of macronucleoli with upgrading and/or absence of OCD (p > 0.05). The size of cribriform pattern was not associated with the absence of OCD (p = 0.43) or Gleason score upgrade (p = 0.28). A proportion of patients with Gleason score 3 + 4 = 7 PCa at needle biopsy do not have OCD or are upgraded to higher Gleason scores after RP. In our study, patients with Gleason score 3 + 4 = 7 PCa with the presence of cribriform pattern 4 had a significantly increased chance of being found to have no OCD at the time of RP. There were no clinical or pathologic parameters at the time of TRUS-guided biopsy that identified risk factors for Gleason score upgrading at RP in this study. Cribriform morphology detected on biopsy in patients with Gleason score 3 + 4 = 7 PCa is associated with tumour upstaging after RP and may be considered a contraindication to active surveillance.

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Conflict of interest

The authors declare that they have no competing interests.

Compliance with ethical standards

We confirm that this study is an original unpublished work and is not being submitted for publication elsewhere. All authors have agreed to this submission in its present form. This is a retrospective study that did not involve patient contact, and all methodologies were approved by our institution’s research ethics board.

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Authors and Affiliations

  1. The Ottawa Hospital, Department of Urology, The University of Ottawa, Ottawa, Canada

    Daniel T. Keefe, Rodney H. Breau & Chris Morash

  2. The Ottawa Hospital, Department of Medical Imaging, The University of Ottawa, Ottawa, Canada

    Nicola Schieda

  3. The Ottawa Hospital, Department of Pathology and Laboratory Medicine, The University of Ottawa, Ottawa, Canada

    Soufiane El Hallani, Susan J. Robertson, Kien T. Mai, Eric C. Belanger & Trevor A. Flood

  4. The Ottawa Hospital, Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Room 4278, Ottawa, ON, K1H 8L6, Canada

    Trevor A. Flood

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  1. Daniel T. Keefe
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  4. Rodney H. Breau
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  9. Trevor A. Flood
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Correspondence to Trevor A. Flood.

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Keefe, D.T., Schieda, N., El Hallani, S. et al. Cribriform morphology predicts upstaging after radical prostatectomy in patients with Gleason score 3 + 4 = 7 prostate cancer at transrectal ultrasound (TRUS)-guided needle biopsy. Virchows Arch 467, 437–442 (2015). https://doi.org/10.1007/s00428-015-1809-5

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  • DOI: https://doi.org/10.1007/s00428-015-1809-5

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