Quantification of extraprostatic extension in prostate cancer: different parameters correlated to biochemical recurrence after radical prostatectomy

• Published in: Histopathology 2011-10, Vol.59 (4), p.692-702
• Main Authors: van Veggel, Bianca A M H, van Oort, Inge M, Witjes, J Alfred, Kiemeney, Lambertus A L M, Hulsbergen-van de Kaa, Christina A
• Format: Article
• Language: English
• Subjects: Adult; Aged; biochemical recurrence; Biological and medical sciences; extraprostatic extension; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - pathology; Neoplasm Staging - methods; Nephrology. Urinary tract diseases; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; radial distance; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1111/j.1365-2559.2011.03986.x

van Veggel B A M H, van Oort I M, Witjes J A, Kiemeney L A L M & Hulsbergen‐van de Kaa C A
(2011) Histopathology59, 692–702 Quantification of extraprostatic extension in prostate cancer: different parameters correlated to biochemical recurrence after radical prostatectomy Aims:  Different methods to substage extraprostatic extension (EPE) were correlated with biochemical recurrence (BCR) after radical prostatectomy (RP). Methods and results:  A total of 157 consecutive RP specimens with EPE were completely embedded. Twenty‐three patients with adjuvant therapy or detectable postoperative PSA levels were excluded, leaving 134 patients for BCR analysis. Data were analysed using Kaplan–Meier survival and Cox regression analyses. In univariate analysis, maximal radial distance (RD) was associated with BCR as continuous (P = 0.006) and dichotomous (P = 0.002) parameters. In multivariate analysis, independent predictors of BCR were preoperative prostate‐specific antigen (PSA) (P = 0.006), Gleason score (P = 0.001), positive surgical margins (P = 0.005), maximal RD dichotomized at 0.6 mm [ = one high‐power field (HPF)]; hazard ratio (HR) 3.4; 95% confidence interval (CI) 1.48–7.85; P = 0.004), total RD (P = 0.009) and EPE quantification according to Epstein (P = 0.002) and to Wheeler (P = 0.004). The 5‐year risk of BCR was 20% (95% CI 0.65–0.94) in patients with RD ≤ 0.6 mm and 47% (95% CI: 0.41–0.65) with RD > 0.6 mm. The restriction of focal EPE in no more than two slides (Epstein and Wheeler) gave no better results. Conclusions:  Maximal RD dichotomized at one HPF is an objective method to subdivide EPE and a strong, independent predictor for BCR after RP. Its use is recommended for substaging pT3a in future TNM classifications.