Prostatic adenocarcinomas with cribriform morphology and/or intraductal carcinoma (CC/IDC) have higher recurrence and mortality rates after radiation and surgery. While the prognostic impact of these features is well-studied, concordance between CC/IDC on biopsy and prostatectomy has only recently gained attention. Our primary objective was to evaluate the diagnostic performance of biopsy for detecting CC/IDC in paired biopsy and prostatectomy specimens in a large contemporary cohort.
Patients who underwent prostate biopsy or had biopsies reviewed prior to prostatectomy at a tertiary hospital between November 2017 and November 2018 were included. Sensitivity and specificity were calculated to assess concordance between CC/IDC on biopsy and prostatectomy. The association of biopsy-diagnosed CC/IDC with adverse pathology was assessed by multivariable regression.
216/455 (47.5%) men that underwent prostatectomy had biopsy-identified CC/IDC. Biopsy sensitivity for CC/IDC was 56.5% and specificity was 87.2%. For active surveillance eligible men, sensitivity was 34.1% and specificity 88.1%. MRI-targeted biopsies did not improve sensitivity (53.5%). While the presence of prostatectomy-identified CC/IDC correlated with adverse pathologic findings, biopsy-identified CC/IDC (compared to CC/IDC negative biopsies) was not independently associated with adverse pathology, likely due to the low sensitivity of biopsy.
In this cohort, biopsy was not sensitive for CC/IDC detection and was not improved by MRI fusion; however, specificity was high suggesting that, when present on biopsy, CC/IDC may be considered in treatment planning algorithms.
The Journal of urology. 2019 Sep 04 [Epub ahead of print]
Kyle J Ericson, Shannon Wu, Scott D Lundy, Lewis J Thomas, Eric A Klein, Jesse K McKenney
Cleveland Clinic, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, Ohio., Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.