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Combining CAPRA-S With Tumor IDC/C Features Improves the Prognostication of Biochemical Recurrence in Prostate Cancer Patients

  • Renu Jeyapala
    Affiliations
    Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada

    Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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  • Shivani Kamdar
    Affiliations
    Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada

    Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada
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  • Ekaterina Olkhov-Mitsel
    Affiliations
    Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada

    Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada
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  • Alexandre Zlotta
    Affiliations
    Departments of Surgery and Surgical Oncology, Division of Urology, University Health Network Toronto, Ontario, Canada
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  • Neil Fleshner
    Affiliations
    Departments of Surgery and Surgical Oncology, Division of Urology, University Health Network Toronto, Ontario, Canada
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  • Tapio Visakorpi
    Affiliations
    Faculty of Medicine and Health Technology, Tampere University and Tays Center, Tampere University Hospital, Tampere, Finland

    Fimlab Laboratories Ltd, Tampere University Hospital, Tampere, Finland

    Department of Pathology and Laboratory Medicine, University Health Network
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  • Theodorus van der Kwast
    Affiliations
    Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada
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  • Bharati Bapat
    Correspondence
    Address for correspondence: Bharati Bapat, PhD, Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada
    Affiliations
    Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Ontario, Canada

    Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada

    Department of Laboratory Medicine and Pathobiology, University of Toronto Toronto, Toronto, Ontario, Canada

    Departments of Surgery and Surgical Oncology, Division of Urology, University Health Network Toronto, Ontario, Canada
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Published:January 14, 2022DOI:https://doi.org/10.1016/j.clgc.2022.01.003

      Abstract

      Background: Intraductal carcinoma and cribriform (IDC/C) tumor features are well-established prognosticators of biochemical recurrence (BCR), metastasis, and prostate cancer (PCa)-specific mortality. However, approximately 70% of PCa patients undergoing a radical prostatectomy are IDC/C negative, yet up-to 20% of these patients progress and experience BCR. Thus, tumor histopathologic characteristics such as IDC/C alone are limited in their ability to predict disease progression. Conversely, several nomograms such as Cancer of the Prostate Risk Assessment-Surgery (CAPRA-S) have been developed to aid in the prognostication of BCR, but not yet widely applied in clinical settings. Materials and methods: In this study, we assessed the combined prognostic utility of IDC/C, and CAPRA-S for BCR in 3 PCa patient cohorts. Results: CAPRA-S+IDC/C improved the predictive accuracy of BCR in all 3 cohorts (P < .001). Specifically, among IDC/C negative cases, CAPRA-S improved the prognostication of BCR in low-risk (Cohort 1; P < .001, Cohort 2; P < .001, Cohort 3; P = .003), intermediate (Cohort 1; P < .001, Cohort 2; P = .006, Cohort 3; P = .03) and high-risk (Cohort 1-3; P < .001) patients. Conversely, IDC/C improved the prognostication of BCR among CAPRA-S low-risk (Cohorts 1; P < .001 and Cohort 3; P = .003) patients. Conclusion: Our results suggest the investigation of histopathological IDC/C features in CAPRA-S low-risk patients and conversely, nomogram CAPRA-S among IDC/C negative patients improves the identification of patients likely to experience BCR, which would otherwise be missed through current assessment regimens. These patients can be offered more intensive monitoring and adjuvant therapies upfront to circumvent the development of recurrent cancer or overtreatment at the time of surgery.

      Keywords

      Abbreviations:

      IDC/C (PCa), CAPRA-S (BCR), GS (GP), GG (PSA)
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