Presentation Authors: Farzana Faisal*, Baltimore, MD, Jeffrey Tosoian, Ann Arbor, MI, Misop Han, Katarzyna Macura, Christian Pavlovich, Tamara Lotan, Baltimore, MD
Introduction: Prostatic adenocarcinoma (PCa) with extraprostatic extension (EPE) detected on prostate needle biopsy (PNB) is an uncommon finding, and its clinical implications are limited. We aimed to describe the clinical and pathologic findings in a large cohort of PCa patients treated with radical prostatectomy (RP) who had EPE identified on PNB.
Methods: Using our institutional pathology database, we identified 83 PCa cases with EPE on PNB between 2000-2018 who underwent treatment with RP and had clinical follow-up information. Clinical, radiographic (pre-RP MRI), and pathologic outcomes were examined.
Results: Sixty-five percent (54/83) of patients presented with clinical stage â‰¥T2 disease. On biopsy, 60% (50/83) of patients had grade group (GG) 4-5, and 81% (66/83) had perineural invasion. Seventeen patients had an MRI performed prior to RP, and 7 of those had EPE noted on the MRI (sensitivity 41%). EPE was confirmed in the RP specimen in 98% (81/83) of cases. At RP, 59% (49/83) had positive surgical margins (PSM), 45% (37/83) had seminal vesicle invasion, and 37% (30/83) had lymph node involvement. PSM occurred in an area of EPE in the RP specimen in 71% (32/45) of patients. Only 34% (15/44) of patients had PSM with the same laterality and prostatic location (i.e. apex, mid, base) as PNB EPE. Median length of follow-up after RP was 2 years. Overall, 45% (34/76) of patients received post-operative radiation at a median of 1 year after RP; 11% (8/73) received chemotherapy at a median of 2 years after RP. The 3-year biochemical recurrence (BCR)-free survival rate was 48.4% (95% CI 0.345-0.610), and the 3-year metastasis-free survival rate was 75.2% (95% CI 0.603-0.851).
Conclusions: Patients with EPE detected on PNB almost always have extraprostatic disease and markedly adverse pathology at RP. Many experience BCR, and most will require multi-modal therapy. As high-risk patients are increasingly considered candidates for RP, these data can be useful in counseling such patients with regards to management approach and expected outcomes after surgery.