Gleason score 7 adenocarcinoma of the prostate with lymph node metastases: Analysis of 184 radical prostatectomy specimens

Oleksandr Kryvenko, Nilesh S. Gupta, Nilam Virani, Daniel Schultz, Juan Gomez, Ali Amin, Zhaoli Lane, Jonathan I. Epstein

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Abstract

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 - Gleasonmatched 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 LN- 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.

Original languageEnglish (US)
Pages (from-to)610-617
Number of pages8
JournalArchives of Pathology and Laboratory Medicine
Volume137
Issue number5
DOIs
StatePublished - May 2013
Externally publishedYes

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Neoplasm Grading
Prostatectomy
Prostate
Adenocarcinoma
Lymph Nodes
Neoplasm Metastasis
Prostatic Neoplasms
Cell Biology
Incidence
Biopsy
Carcinoma, Intraductal, Noninfiltrating
Seminal Vesicles
Prostate-Specific Antigen
Tumor Burden
Lymph Node Excision

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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Gleason score 7 adenocarcinoma of the prostate with lymph node metastases : Analysis of 184 radical prostatectomy specimens. / Kryvenko, Oleksandr; Gupta, Nilesh S.; Virani, Nilam; Schultz, Daniel; Gomez, Juan; Amin, Ali; Lane, Zhaoli; Epstein, Jonathan I.

In: Archives of Pathology and Laboratory Medicine, Vol. 137, No. 5, 05.2013, p. 610-617.

Research output: Contribution to journalArticle

Kryvenko, Oleksandr ; Gupta, Nilesh S. ; Virani, Nilam ; Schultz, Daniel ; Gomez, Juan ; Amin, Ali ; Lane, Zhaoli ; Epstein, Jonathan I. / Gleason score 7 adenocarcinoma of the prostate with lymph node metastases : Analysis of 184 radical prostatectomy specimens. In: Archives of Pathology and Laboratory Medicine. 2013 ; Vol. 137, No. 5. pp. 610-617.
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abstract = "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 - Gleasonmatched 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 LN- 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.",
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T1 - Gleason score 7 adenocarcinoma of the prostate with lymph node metastases

T2 - Analysis of 184 radical prostatectomy specimens

AU - Kryvenko, Oleksandr

AU - Gupta, Nilesh S.

AU - Virani, Nilam

AU - Schultz, Daniel

AU - Gomez, Juan

AU - Amin, Ali

AU - Lane, Zhaoli

AU - Epstein, Jonathan I.

PY - 2013/5

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N2 - 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 - Gleasonmatched 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 LN- 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.

AB - 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 - Gleasonmatched 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 LN- 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.

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