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Prostate Cancer
Extraprostatic Extension Is Extremely Rare for Contemporary
Gleason Score 6 Prostate Cancer
Blake B. Anderson
a , * ,Daniel T. Oberlin
b ,Aria A. Razmaria
a ,Bonnie Choy
c ,Gregory P. Zagaja
a ,Arieh L. Shalhav
a ,Joshua J. Meeks
b ,Ximing J. Yang
d ,Gladell P. Paner
a , c , y, Scott E. Eggener
a , ya
Section of Urology, University of Chicago, Chicago, IL, USA;
b
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
c
Department of Pathology, University of Chicago, Chicago, IL, USA;
d
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago,
IL, USA
1.
Introduction
Previous studies
[1,2]have demonstrated that Gleason
score 6 (GS6) prostatic adenocarcinoma, using the 2005
International Society of Urological Pathology (ISUP) defini-
tion and criteria that evolved into the 2014 ISUP definition
[3,4], only rarely, if ever, has the ability to metastasize. With
recent modifications in Gleason grading
[4] ,it is crucial to
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 4 5 5 – 4 6 0ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comArticle info
Article history:
Accepted November 23, 2016
Associate Editor:
Matthew Cooperberg
Keywords:
Male
Neoplasm grading
Prostatectomy
Prostatic neoplasms
Seminal vesicles
Abstract
Background:
A significant proportion of men with Gleason score 6 (GS6) prostate cancer
undergo treatment with radiation or surgery.
Objective:
To assess pathologic stage of pure GS6 at radical prostatectomy (RP).
Design, setting, and participants:
In the period 2003–2014, 7817 patients underwent RP
at two institutions. Of 2502 patients with GS6 at surgery, 60 were identified as stage
pT3a–b on initial pathologic review, 55 with pT3a (extraprostatic extension, EPE), and
five with pT3b (seminal vesicle invasion; SVI). All cases of GS6 with pT3 disease
underwent contemporary pathologic evaluation for Gleason grade, stage, and extent
of EPE. At one institution, all GS 7 pT3b cases were re-reviewed for downgrading. The
2014 International Society of Urological Pathology (ISUP) Gleason grading criteria and
2009 ISUP recommendations on pT3 staging were applied.
Outcome measurements and statistical analysis:
Calculated incidence (%) of pT3a, pT3b,
pT4, and lymph node-positive disease.
Results and limitations:
Of the 60 GS6 pT3a–b cases identified in the period 2003–2014,
seven (0.28% of entire GS6 cohort) with GS6 and pT3a were identified after re-review, all
focal EPE. Among the re-examined cohort, no cases of GS6 with pT3b were observed.
None of the 132 GS 7 pT3b cases were downgraded to GS6. Limitations include partial
embedding of specimens and separate pathologic review at each institution.
Conclusions:
In a large prostatectomy cohort, GS6 never had seminal vesicle invasion
(0%) and was very rarely (0.28%) associated with extraprostatic extension.
Patient summary:
GS6 prostate cancer rarely spreads outside the prostate. A new
finding in this study was that GS6 prostate cancer never spread to the seminal vesicles.
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2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
y
Co-senior authors.
* Corresponding author. Section of Urology, The University of Chicago Medicine, 5841 S. Maryland
Avenue, MC6038, IL 60637, USA. Tel. +1 773 7029757; Fax: +1 773 7021001.
E-mail address:
Blake.Anderson@uchospitals.edu(B.B. Anderson).
http://dx.doi.org/10.1016/j.eururo.2016.11.0280302-2838/
#
2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.