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01-05-2014 | Original Article

Re-evaluating the concept of “dominant/index tumor nodule” in multifocal prostate cancer

Authors: Cheng Cheng Huang, Fang-Ming Deng, Max X. Kong, Qinhu Ren, Jonathan Melamed, Ming Zhou

Published in: Virchows Archiv | Issue 5/2014

Abstract

Prostate cancer (PCa) often presents as a multifocal disease with heterogeneity in Gleason score (GS) and genetic alterations. Dominant/index tumor nodule (DN), the largest nodule in a multifocal disease, is presumed to harbor the most aggressive biological behavior and therefore dictate the overall clinical behavior of PCa. In this study, we examined the pathological features of DN and re-evaluated the validity of the “DN” concept in multifocal PCa. A total of 201 consecutive radical prostatectomy specimens were totally submitted and examined. All independent cancer foci were recorded with prognostically important pathological parameters. Unifocal and multifocal disease was present in 25 (12.4 %) and 176 (87.6 %) cases, respectively. In 20 (11.3 %) multifocal cases, the highest GS, the largest tumor volume (TV), and extraprostatic extension (EPE) did not concur in the same tumor nodules. Non-DNs had a higher GS and EPE in 13 cases each and had both the highest GS and EPE in 5 cases. In the majority of multifocal prostate cancer (88.7 %), DNs have the highest GS and EPE. In these cases, DN is still a valid concept and can be used for assigning overall GS and procuring tissue for research. However, in a significant number of cases (11.3 %), the largest TV, the highest GS, and EPE did not concur in the same tumor nodules. In these cases, pathologists should de-emphasize the concept of DN. Instead, they should place the emphasis on the multifocal nature of the disease and document the pathological features of all independent tumor foci that have the largest TV, the highest GS, and EPE.

Greene DR, Wheeler TM, Egawa S et al (1991) A comparison of the morphological features of cancer arising in the transition zone and in the peripheral zone of the prostate. J Urol 146:1069–1076PubMed

Villers A, McNeal JE, Freiha FS et al (1992) Multiple cancers in the prostate. Morphologic features of clinically recognized versus incidental tumors. Cancer 70:2313–2318PubMedCrossRef

Miller GJ, Cygan JM (1994) Morphology of prostate cancer: the effects of multifocality on histological grade, tumor volume and capsule penetration. J Urol 152:1709–1713PubMed

Arora R, Koch MO, Eble JN et al (2004) Heterogeneity of Gleason grade in multifocal adenocarcinoma of the prostate. Cancer 100:2362–2366PubMedCrossRef

Cheng L, Jones TD, Pan CX et al (2005) Anatomic distribution and pathologic characterization of small-volume prostate cancer (<0.5 ml) in whole-mount prostatectomy specimens. Mod Pathol 18:1022–1026PubMedCrossRef

Wise AM, Stamey TA, McNeal JE et al (2002) Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 60:264–269PubMedCrossRef

Andreoiu M, Cheng L (2010) Multifocal prostate cancer: biologic, prognostic, and therapeutic implications. Hum Pathol 41:781–793PubMedCrossRef

Ruijter ET, van de Kaa CA, Schalken JA et al (1996) Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol 180:295–299PubMedCrossRef

Cheng L, Song SY, Pretlow TG et al (1998) Evidence of independent origin of multiple tumors from patients with prostate cancer. J Natl Cancer Inst 90:233–237PubMedCrossRef

10.

Mehra R, Han B, Tomlins SA et al (2007) Heterogeneity of TMPRSS2 gene rearrangements in multifocal prostate adenocarcinoma: molecular evidence for an independent group of diseases. Cancer Res 67:7991–7995PubMedCrossRef

11.

McNeal JE, Price HM, Redwine EA et al (1988) Stage A versus stage B adenocarcinoma of the prostate: morphological comparison and biological significance. J Urol 139:61–65PubMed

12.

Epstein JI, Allsbrook WC Jr, Amin MB et al (2005) The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 29:1228–1242PubMedCrossRef

13.

van der Kwast TH, Amin MB, Billis A et al (2011) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working Group 2: T2 substaging and prostate cancer volume. Mod Pathol 24:16–25PubMedCrossRef

14.

Billis A, Freitas LL, Magna LA et al (2004) Prostate cancer with bladder neck involvement: pathologic findings with application of a new practical method for tumor extent evaluation and recurrence-free survival after radical prostatectomy. Int Urol Nephrol 36:363–368PubMedCrossRef

15.

Yoon GS, Wang W, Osunkoya AO et al (2008) Residual tumor potentially left behind after local ablation therapy in prostate adenocarcinoma. J Urol 179:2203–2206PubMedCentralPubMedCrossRef

16.

Chen ME, Johnston DA, Tang K et al (2000) Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 89:1800–1809PubMedCrossRef

17.

Magi-Galluzzi C, Evans AJ, Delahunt B et al (2011) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease. Mod Pathol 24:26–38PubMedCrossRef

18.

Tan PH, Cheng L, Srigley JR et al (2011) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins. Mod Pathol 24:48–57PubMedCrossRef

19.

Bastacky SI, Wojno KJ, Walsh PC et al (1995) Pathological features of hereditary prostate cancer. J Urol 153:987–992PubMedCrossRef

20.

Kastendieck H (1980) Correlations between atypical primary hyperplasia and carcinoma of the prostate. A histological study of 180 total prostatectomies. Pathol Res Pract 169:366–387PubMedCrossRef

21.

Cheng L, Poulos CK, Pan CX et al (2005) Preoperative prediction of small volume cancer (less than 0.5 ml) in radical prostatectomy specimens. J Urol 174:898–902PubMedCrossRef

22.

Byar DP, Mostofi FK (1972) Carcinoma of the prostate: prognostic evaluation of certain pathologic features in 208 radical prostatectomies. Examined by the step-section technique. Cancer 30:5–13PubMedCrossRef

23.

Qian J, Bostwick DG (1995) The extent and zonal location of prostatic intraepithelial neoplasia and atypical adenomatous hyperplasia: relationship with carcinoma in radical prostatectomy specimens. Pathol Res Pract 191:860–867PubMedCrossRef

24.

Eichelberger LE, Cheng L (2004) Does pT2b prostate carcinoma exist? Critical appraisal of the 2002 TNM classification of prostate carcinoma. Cancer 100:2573–2576PubMedCrossRef

25.

Cheng L, Pisansky TM, Ramnani DM et al (2000) Extranodal extension in lymph node-positive prostate cancer. Mod Pathol 13:113–118PubMedCrossRef

26.

Aihara M, Wheeler TM, Ohori M et al (1994) Heterogeneity of prostate cancer in radical prostatectomy specimens. Urology 43:60–66, discussion 66-67PubMedCrossRef

27.

Bostwick DG, Shan A, Qian J et al (1998) Independent origin of multiple foci of prostatic intraepithelial neoplasia: comparison with matched foci of prostate carcinoma. Cancer 83:1995–2002PubMedCrossRef

28.

Epstein JI, Walsh PC, Carmichael M et al (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271:368–374PubMedCrossRef

29.

Noguchi M, Stamey TA, McNeal JE et al (2003) Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. J Urol 170:459–463PubMedCrossRef

30.

Epstein JI (2011) Prognostic significance of tumor volume in radical prostatectomy and needle biopsy specimens. J Urol 186:790–797PubMedCrossRef

31.

Sakr WA, Macoska JA, Benson P et al (1994) Allelic loss in locally metastatic, multisampled prostate cancer. Cancer Res 54:3273–3277PubMed

32.

Schmidt H, DeAngelis G, Eltze E et al (2006) Asynchronous growth of prostate cancer is reflected by circulating tumor cells delivered from distinct, even small foci, harboring loss of heterozygosity of the PTEN gene. Cancer Res 66:8959–8965PubMedCrossRef

33.

Stamey TA, McNeal JE, Yemoto CM et al (1999) Biological determinants of cancer progression in men with prostate cancer. JAMA 281:1395–1400PubMedCrossRef

34.

Cheng L, Koch MO, Juliar BE et al (2005) The combined percentage of Gleason patterns 4 and 5 is the best predictor of cancer progression after radical prostatectomy. J Clin Oncol 23:2911–2917PubMedCrossRef

35.

Cheng L, Davidson DD, Lin H et al (2007) Percentage of Gleason pattern 4 and 5 predicts survival after radical prostatectomy. Cancer 110:1967–1972PubMedCrossRef

36.

Abdollah F, Schmitges J, Sun M et al (2011) Head-to-head comparison of three commonly used preoperative tools for prediction of lymph node invasion at radical prostatectomy. Urology 78:1363–1367PubMedCrossRef

37.

Allaf ME, Palapattu GS, Trock BJ et al (2004) Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 172:1840–1844PubMedCrossRef

38.

von Bodman C, Godoy G, Chade DC et al (2010) Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy. J Urol 184:143–148CrossRef

39.

Ross HM, Kryvenko ON, Cowan JE et al (2012) Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? Am J Surg Pathol 36:1346–1352PubMedCentralPubMedCrossRef

40.

Fine SW, Amin MB, Berney DM et al (2012) A contemporary update on pathology reporting for prostate cancer: biopsy and radical prostatectomy specimens. Eur Urol 62:20–39PubMedCrossRef

Title: Re-evaluating the concept of “dominant/index tumor nodule” in multifocal prostate cancer
Authors: Cheng Cheng Huang
Fang-Ming Deng
Max X. Kong
Qinhu Ren
Jonathan Melamed
Ming Zhou
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: Virchows Archiv / Issue 5/2014
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-014-1557-y

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Re-evaluating the concept of “dominant/index tumor nodule” in multifocal prostate cancer

Abstract

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Abstract

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