Impact of Epithelial Histological Types, Subtypes, and Growth Patterns on Oncological Outcomes for Patients with Nonmetastatic Prostate Cancer Treated with Curative Intent: A Systematic Review.
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Marra Giancarlo, van Leenders Geert J L H, Zattoni Fabio, Kesch Claudia, Rajwa Pawel, Cornford Philip, van der Kwast Theodorus, van den Bergh Roderick C N, Briers Erik, Van den Broeck Thomas, De Meerleer Gert, De Santis Maria, Eberli Daniel, Farolfi Andrea, Gillessen Silke, Grivas Nikolaos, Grummet Jeremy P, Henry Ann M, Lardas Michael, Lieuw Matt, Linares Espinós Estefania, Mason Malcolm D, O'Hanlon Shane, van Oort Inge M, Oprea-Lager Daniela E, Ploussard Guillaume, Rouvière Olivier, Schoots Ivo G, Stranne Johan, Tilki Derya, Wiegel Thomas, Willemse Peter-Paul M, Mottet Nicolas, Gandaglia Giorgio, European Association of Urology Young Academic Urologists Prostate Cancer Working Group, the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines Panel on Prostate Cancer
Аннотация
OBJECTIVE: To compare oncological outcomes for conventional and UH PCa in men with localized disease treated with curative intent.
EVIDENCE ACQUISITION: A systematic review adhering to the Referred Reporting Items for Systematic Reviews and Meta-Analyses was prospectively registered on PROSPERO (CRD42022296013) was performed in July 2021.
EVIDENCE SYNTHESIS: We screened 3651 manuscripts and identified 46 eligible studies (reporting on 1 871 814 men with conventional PCa and 6929 men with 10 different PCa UHs). Extraprostatic extension and lymph node metastases, but not positive margin rates, were more common with UH PCa than with conventional tumors. PCa cases with cribriform pattern, intraductal carcinoma, or ductal adenocarcinoma had higher rates of biochemical recurrence and metastases after radical prostatectomy than for conventional PCa cases. Lower cancer-specific survival rates were observed for mixed cribriform/intraductal and cribriform PCa. By contrast, pathological findings and oncological outcomes for mucinous and prostatic intraepithelial neoplasia (PIN)-like PCa were similar to those for conventional PCa. Limitations of this review include low-quality studies, a risk of reporting bias, and a scarcity of studies that included radiotherapy.
CONCLUSIONS: Intraductal, cribriform, and ductal UHs may have worse oncological outcomes than for conventional and mucinous or PIN-like PCa. Alternative treatment approaches need to be evaluated in men with these cancers.
PATIENT SUMMARY: We reviewed the literature to explore whether prostate cancers with unconventional growth patterns behave differently to conventional prostate cancers. We found that some unconventional growth patterns have worse outcomes, so we need to investigate if they need different treatments. Urologists should be aware of these growth patterns and their clinical impact.