Intraductal carcinoma and cribriform (IDC/C) tumor features are well-established prognosticators of biochemical recurrence (BCR), metastasis, and prostate cancer (PCa)-specific mortality. However, approximately 70% of PCa patients undergoing a radical prostatectomy are IDC/C negative, yet up-to 20% of these patients progress and experience BCR. Thus, tumor histopathologic characteristics such as IDC/C alone are limited in their ability to predict disease progression. Conversely, several nomograms such as Cancer of the Prostate Risk Assessment-Surgery (CAPRA-S) have been developed to aid in the prognostication of BCR, but not yet widely applied in clinical settings.
In this study, we assessed the combined prognostic utility of IDC/C, and CAPRA-S for BCR in 3 PCa patient cohorts.
CAPRA-S+IDC/C improved the predictive accuracy of BCR in all 3 cohorts (P < .001). Specifically, among IDC/C negative cases, CAPRA-S improved the prognostication of BCR in low-risk (Cohort 1; P < .001, Cohort 2; P < .001, Cohort 3; P = .003), intermediate (Cohort 1; P < .001, Cohort 2; P = .006, Cohort 3; P = .03) and high-risk (Cohort 1-3; P < .001) patients. Conversely, IDC/C improved the prognostication of BCR among CAPRA-S low-risk (Cohorts 1; P < .001 and Cohort 3; P = .003) patients.
Our results suggest the investigation of histopathological IDC/C features in CAPRA-S low-risk patients and conversely, nomogram CAPRA-S among IDC/C negative patients improves the identification of patients likely to experience BCR, which would otherwise be missed through current assessment regimens. These patients can be offered more intensive monitoring and adjuvant therapies upfront to circumvent the development of recurrent cancer or overtreatment at the time of surgery.
Clinical genitourinary cancer. 2022 Jan 15 [Epub]
Renu Jeyapala, Shivani Kamdar, Ekaterina Olkhov-Mitsel, Alexandre Zlotta, Neil Fleshner, Tapio Visakorpi, Theodorus van der Kwast, Bharati Bapat
Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada., Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada., Departments of Surgery and Surgical Oncology, Division of Urology, University Health Network Toronto, Ontario, Canada., Faculty of Medicine and Health Technology, Tampere University and Tays Center, Tampere University Hospital, Tampere, Finland; Fimlab Laboratories Ltd, Tampere University Hospital, Tampere, Finland; Department of Pathology and Laboratory Medicine, University Health Network., Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada., Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada; Departments of Surgery and Surgical Oncology, Division of Urology, University Health Network Toronto, Ontario, Canada. Electronic address: .