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Does prostate cancer without cribriform pattern have metastatic potential?

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Pathological growth patterns are the mainstay in the classification of prostate cancer (PCa) patients. It is well-established that patients with Gleason pattern 3/Grade group (GG) 1 at radical prostatectomy (RP) have very low, if any, risk of developing metastasis or deceasing from PCa, albeit having a low 5–11% risk of biochemical recurrence (BCR) [1, 2]. To the contrary, recent studies show negative impact of invasive cribriform and intraductal carcinoma (CR/IDC) on long-term oncological outcomes such as BCR, metastatic development and PCa death [3, 4]. CR/IDC is putatively a morphological substrate of underlying genomic instability such as PTEN loss and c-MYC gain [4, 5]. Whereas acquirement of metastatic potential is reflective of aberrant pathophysiological capacity, BCR is also related to tumor volume and incomplete tumor resection. Therefore, we hypothesize that the impact of CR/IDC on development of metastasis is stronger than on BCR. Our objective is to compare biochemical recurrence-free survival (BCRFS) and metastasis-free survival (MFS) of PCa patients with and without CR/IDC at RP.

This retrospective study included 835 patients who had undergone RP without prior hormonal or radiation therapy between 2000 and 2017 at Erasmus Medical Centre, The Netherlands. The histopathological characteristics after detailed revision according to the 2014 International Society of Urological Pathology (ISUP) recommendations have been described previously [6]. BCR was defined as prostate-specific antigen (PSA) ≥ 0.2 ng/ml, measured at two consecutive points in time, after being undetectable after operation or, if serum PSA level had not declined to zero, as an increase of >2.0 ng/ml. Metastasis could be nodal disease at pelvic lymph node dissection (PLND), postoperative lymph node or distant metastases confirmed by pathological evaluation or multidisciplinary consensus.

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Fig. 1: Kaplan–Meier curves, Logrank-test and Cox regression analysis.

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Funding

This work was supported by a grant of the Jaap Schouten Foundation to LJK.

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Authors and Affiliations

  1. Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands

    Lisa J. Kroon, Eva Hollemans & Geert J. L. H. van Leenders

  2. Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands

    Lisa J. Kroon, Sebastiaan Remmers, Chris H. Bangma & Monique J. Roobol

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  1. Lisa J. Kroon
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  6. Geert J. L. H. van Leenders
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Contributions

LJK designed the study, performed data analysis and drafted the manuscript, SR assisted with data analysis and interpretation. EH collected the data. CHB, MJR and GJLHL made substantial contributions to the preparation and revision of the manuscript. GJLHL supervised. All authors approved the final version of the manuscript.

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Correspondence to Lisa J. Kroon.

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The authors declare no competing interests.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The Erasmus Medical Centre institutional Medical Research Ethics Committee (MEC-2018-1614) approved this study. Informed consent was waived for this retrospective study.

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Kroon, L.J., Remmers, S., Hollemans, E. et al. Does prostate cancer without cribriform pattern have metastatic potential?. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00802-6

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