Cribriform intraductal carcinoma of the prostate may be more aggressive than cribriform conventional/acinar prostatic adenocarcinoma

Abstract

It remains to be determined if the prognostic value of cribriform morphology (Crib) associated with intraductal carcinoma of the prostate (IDC) is equivalent to that in conventional/acinar prostatic adenocarcinoma (CPA). We herein assessed radical prostatectomy findings and long-term oncologic outcomes in 732 men with Grade Group 2-4 CPA without any Gleason pattern 5. Our cases were divided into four cohorts according to the absence or presence of Crib within CPA and/or IDC: Cohort-1, no Crib (n=347; 47.4%); Cohort-2, Crib only in CPA (n=203; 27.7%); Cohort-3, Crib only in IDC (n=17; 2.3%); and Cohort-4, Crib in both CPA and IDC (n=165; 22.5%). Compared with that in CPA only (Cohort-2), Crib in both CPA and IDC (Cohort-4) was significantly associated with adverse histopathological features, including higher tumour grade/stage and larger tumour volume. Univariate analysis revealed significantly higher risks of postoperative recurrence in patients with Crib in IDC only [Cohort-3; hazard ratio (HR) 2.450, p=0.022] or both CPA and IDC (Cohort-4; HR 2.835, p<0.001) than in those with Crib in CPA only (Cohort-2), whereas the prognosis was analogous between Cohort-3 and Cohort-4 (p=0.913). In a multivariable analysis [Crib in CPA only (Cohort-2) as a reference], Crib in IDC only (Cohort-3; HR 3.821, p=0.002) or both CPA and IDC (Cohort-4; HR 1.905, p=0.004) showed significantly worse recurrence-free survival. Compared with Crib in CPA only, its presence in both CPA and IDC was thus found to be independently associated with a poorer prognosis, suggesting a potentially greater clinical impact of Crib in IDC than in CPA.

Keywords: biochemical recurrence; conventional/acinar prostatic adenocarcinoma; cribriform morphology; intraductal carcinoma of the prostate; prostate cancer; radical prostatectomy.