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. 2024 Jul-Aug;44(4):234-248.
doi: 10.5144/0256-4947.2024.234. Epub 2024 Aug 1.

Evaluating the effect of histopathological parameters of prostate adenocarcinoma on prognosis in radical prostatectomy specimens

Ergün Tercan  1 , O Uzcan Erbatu  2 , Oktay Üçer  2 , Sefa Metin  3 , Nalan Ne E  1
Affiliations

Evaluating the effect of histopathological parameters of prostate adenocarcinoma on prognosis in radical prostatectomy specimens

Ergün Tercan et al. Ann Saudi Med. 2024 Jul-Aug.

Abstract

Background: Over the past decade, significant updates have been made regarding the classification and grading of prostate adenocarcinoma in radical prostatectomy specimens, following decisions reached in international conferences and through impactful publications. These alterations are closely linked to patient prognosis.

Objectives: Observe the incidence of these changes and their impact on patient prognosis. Additionally, investigate the relationship between histopathological and clinical parameters to assist in multidisciplinary treatment planning.

Design: Retrospective cohort study.

Setting: Tertiary university hospital.

Methods: Hematoxylin and eosin, along with immunohistochemistry stained sections, were reevaluated, and clinical information, including patient demographics, preoperative PSA levels, and patient follow-up were collected from patients who underwent radical prostatectomy at our center.

Sample size: 182 patients.

Main outcome measures: Biochemical recurrence.

Results: The study highlighted the negative prognostic effects of factors such as Gleason grade group, lymphovascular invasion, intraductal carcinoma, positive surgical margins, extraprostatic extension, pathological T stage, and seminal vesicle invasion. These factors are important determinants of recurrence-free survival in prostate adenocarcinoma patients.

Conclusion: This study identified comedonecrosis and intraductal carcinoma as independent negative prognostic factors. A 3-mm cutoff for positive surgical margins was supported, while the current cutoff for extraprostatic extension may require reevaluation. The impact of cribriform pattern and ductal carcinoma appears to be influenced by the grade group. No independent relationship was found between the Gleason score/pattern on positive surgical margins or extraprostatic extension and prognosis. Further, large-scale studies with long-term follow-up are needed.

Limitations: The study is limited by the relatively small number of patients for certain parameters.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
A) Cribriform structures in Gleason pattern 4 tumors. B) Extraprostatic extension. C) Intraductal carcinoma. D) Immunohistochemical staining of P63 and ERG cocktail (Red chromogen: ERG, brown chromogen: P63).
Figure 2.
Figure 2.
A) Comedonecrosis in invasive tumor. B) Necrosis in the intraductal carcinoma. C) Ductal carcinoma area. D) A difficult case to evaluate PSM-GS due to diffuse thermal damage.
Figure 3.
Figure 3.
A Kaplan-Meier curve showing the relationship between presence of intraductal carcinoma and recurrence-free survival. B Kaplan-Meier curve showing the relationship between presence of ductal component and recurrence-free survival
See this image and copyright information in PMC

References

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