Cribriform pattern with intraductal carcinoma tied to adverse outcomes in Gleason 7 prostate cancer
05 Nov 2019
Prostate cancer is a silent killer. Many may not be aware of the illness until it is too late.An association exists between cribriform pattern with intraductal carcinoma and adverse outcomes in men with Gleason 7 prostate cancer treated with external beam radiotherapy, reports a study. Cribriform pattern without intraductal carcinoma shows no association.
A total of 237 patients were analysed, with a median follow-up of 117 months (range, 3–236). Based on National Comprehensive Cancer Network risk groups, 24 percent of patients were at favourable intermediate risk, 53 percent unfavourable intermediate risk and 23 percent high risk.
The rates of cribriform pattern without intraductal carcinoma, cribriform pattern with intraductal carcinoma, intraductal carcinoma without cribriform pattern were 36 percent, 13 percent and 0 percent, respectively. Fifty-one percent of patients did not fall in any of these morphologies.
Multivariate analysis indicated the association of cribriform pattern with intraductal carcinoma (hazard ratio [HR], 4.22, 95 percent confidence interval [CI], 2.08–8.53; p<0.0001), prostate-specific antigen 10–20 ng/ml (HR, 1.97, 95 percent CI, 1.03–3.79; p=0.04) and prostate-specific antigen >20 ng/ml (HR, 2.26, 95 percent CI, 1.21–4.23; p=0.01) with worse biochemical recurrence-free survival.
Additionally, only cribriform pattern with intraductal carcinoma correlated with inferior distant metastasis-free survival (HR, 4.18, 95 percent CI, 1.43–12.28; p=0.01) and disease-specific survival (HR, 14.26, 95 percent CI, 2.75–74.04; p=0.0016). Grade group 3, high-risk group and ≥50-percent positive biopsy cores were associated with cribriform pattern with or without intraductal carcinoma.
Stratification by neither morphology present, cribriform pattern without intraductal carcinoma and cribriform pattern with intraductal carcinoma demonstrated statistically significant differences in biochemical recurrence-free (p=0.00042), distant metastasis-free (p=0.017) and disease-specific survival (p<0.001).
“Future studies may benefit from dichotomizing these two histological entities,” the investigators said.
In this study, men with Gleason 7 (grade groups 2 and 3) prostate cancer treated with dose-escalated external beam radiotherapy with or without androgen deprivation were analysed. Biopsies for the presence of cribriform pattern and/or intraductal carcinoma were also reviewed.