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Gleason Score 7 Adenocarcinoma of the Prostate With Lymph Node Metastases: Analysis of 184 Radical Prostatectomy Specimens

2013; American Medical Association; Volume: 137; Issue: 5 Linguagem: Inglês

10.5858/arpa.2012-0128-oa

1543-2165

Oleksandr N. Kryvenko, Nilesh Gupta, Nilam Virani, Daniel Schultz, Juan Farak Gómez, Ali Amin, Zhaoli Lane, Jonathan I. Epstein,

Urologic and reproductive health conditions

Context.—Prostate cancer (PC) with lymph node metastases (LN+) is relatively rare, whereas it is relatively common in disease with a Gleason score (GS) 8 to 10 and virtually never seen in PC with GS 6 or less. It is most variable in GS 7 PC. Objective.—To determine clinicopathologic features associated with GS 7 PC with LN+ compared with a control group without lymph node metastases (LN−). Design.—We analyzed 184 GS 7 radical prostatectomies with LN+ and the same number of LN− Gleason-matched controls. The LN+ cases were GS 3 + 4 = 7 (n = 64; 34.8%), GS 4 + 3 = 7 (n = 66; 35.9%), GS 3 + 4 = 7 with tertiary 5 (n = 10; 5.4%), and GS 4 + 3 = 7 with tertiary 5 (n = 44; 23.9%). Results.—The LN+ cases demonstrated higher average values in preoperative prostate-specific antigen (12.2 versus 8.1 ng/mL), percentage of positive biopsy cores (59.1% versus 42.9%), prostate weight (54.4 versus 49.4 g), number of LNs submitted (12.7 versus 9.4), incidence of nonfocal extraprostatic extension (82.6% versus 63.6%), tumor volume (28.9% versus 14.8%), frequency of lymphovascular invasion (78.3% versus 38.6%), intraductal spread of carcinoma (42.4% versus 20.7%), incidence of satellite tumor foci (16.4% versus 4.3%), incidence of pT3b disease (49.5% versus 14.7%), and lymphovascular invasion in the seminal vesicles (52% versus 30%). There were differences in GS 4 patterns and cytology between LN+ and LN− cases, with the former having higher volumes of cribriform and poorly formed patterns, larger nuclei and nucleoli, and more-frequent macronucleoli. All P ≤ .05. Conclusion.—Gleason score 7 PC with LN+ has features highlighting a more-aggressive phenotype. These features can be assessed as prognostic markers in GS 7 disease on biopsy (eg, GS 4 pattern, intraductal spread, cytology) or at radical prostatectomies (all variables), even in men without LN dissection or LN− disease.