title: Extraprostatic extension (EPE) of prostatic carcinoma: is its proximity to the surgical margin or Gleason score important?
abstract: OBJECTIVE
  To examine the association between histopathological factors of extraprostatic prostate cancer and outcome.
  
  
  METHODS
  Patients with extraprostatic extension (EPE) without positive margins, seminal vesicle or lymph node involvement were analysed from a consecutive radical prostatectomy cohort of 1136 (2002-2006) for: (i) distance of EPE from the margin; (ii) Gleason score of the EPE; and (iii) extent of EPE. Log-rank, Kaplan-Meier, and Cox regression analyses were performed.
  
  
  RESULTS
  The study included 194 pT3a, pN0, R0 patients with a median follow-up of 5.4 years, with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with a Gleason score of ≥8 in the extraprostatic portion showed increased incidence of BCR compared with those with Gleason scores of ≤7 (P = 0.03). The proximity of the EPE to the margin (0.01-7.5 mm) did not correlate with BCR. On multivariable analysis, the extent of EPE, the Gleason score of the dominant nodule or of the EPE portion did not correlate with BCR.
  
  
  CONCLUSIONS
  Data from this study using current International Society of Urological Pathology Gleason scoring and EPE criteria indicate that close proximity of EPE to the margin is not associated with recurrence. Gleason score ≥8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.
authors.affiliation: Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Cancer Research Program, The Kinghorn Cancer Centre/Garvan Institute of Medical Research, Sydney, NSW, Australia.
authors.forename: Ruta
authors.initials: R
authors.lastname: Gupta
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: O'Connell
authors.affiliation: Cancer Research Program, The Kinghorn Cancer Centre/Garvan Institute of Medical Research, Sydney, NSW, Australia.
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Haynes
authors.affiliation: Department of Urology, St. Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Stricker
authors.affiliation: Department of Anatomic Pathology, St. Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Wade
authors.initials: W
authors.lastname: Barrett
authors.affiliation: Douglass Hanly Moir Pathology, Macquarie University, Sydney, NSW, Australia.|The Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Turner
authors.affiliation: Douglass Hanly Moir Pathology, Macquarie University, Sydney, NSW, Australia.
authors.forename: Warick
authors.initials: W
authors.lastname: Delprado
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Cancer Research Program, The Kinghorn Cancer Centre/Garvan Institute of Medical Research, Sydney, NSW, Australia.|Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Horvath
authors.affiliation: Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Cancer Research Program, The Kinghorn Cancer Centre/Garvan Institute of Medical Research, Sydney, NSW, Australia.
authors.forename: James G
authors.initials: JG
authors.lastname: Kench
mesh_terms: D000368:Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery
keywords: Gleason scores; extraprostatic extension; margins; prostate; prostatic adenocarcinoma; radical prostatectomy