CRIBRIFORM CARCINOMA OF THE PROSTATE AND CRIBRIFORM PROSTATIC INTRAEPITHELIAL NEOPLASIA - INCIDENCE AND CLINICAL IMPLICATIONS

Cribriform neoplasia of the prostate can be recognized easily. However , controversy persists regarding terminology, particularly with the in traductal spread of cribriform neoplasia; some consider this ''intradu ctal carcinoma,'' whereas consensus meetings defined these lesions as high-grade cribriform prostatic intraepithelial neoplasia (HGCP). This study attempts to identify the incidence and clinical significance of HGCP and cribriform carcinoma (CC) by evaluating 114 radical prostate ctomy specimens. Cases were divided into three histologic groups for s tatistical analysis: (1) pure acinar carcinoma: infiltrating acinar ca rcinoma without evidence of cribriform neoplasia; (2) CC: acinar carci noma with CC; and (3) HGCP: acinar carcinoma with HGCP. High-grade cri briform prostatic intraepithelial neoplasia was defined as the presenc e of neoplastic cells spanning the entire lumen in a cribriform config uration in which a basal cell layer could be shown by immunohistochemi stry. Similar areas in which no basal cell layer could be seen were di agnosed as CC. The incidence of cribriform neoplasia was 38% (43 of 11 4). The incidences of HGCP and CC were 13% (15 of 114) and 25% (28 of 114), respectively. Univariate analysis showed a strong association be tween HGCP and CC both and several preoperative and final pathology re sults, including digital rectal examination, pathology tumor stage, ex traprostatic extension, surgical margin positivity, high Gleason sum ( GS), and high tumor volume. Kaplan-Meier analysis showed HGCP to have a 61% cumulative prostate-specific antigen (PSA) failure rate in contr ast with CC and pure acinar cancer, which had cumulative PSA failure r ates of 15% and 13%, respectively (p = 0.0001, log-rank test). Multiva riate Cox's proportional-hazards analysis found preoperative serum PSA , GS, tumor stage, and volume to be important predictors of PSA failur e. In a second regression model that included serum PSA, GS, and patho logy tumor stage, HGCP was an independent predictor of PSA failure. Bo th HGCP and CC are closely associated with several poor prognostic ind icators, including advanced pathology tumor stage, a high GS, and seru m PSA. Multivariate analysis showed HGCP as an independent prognostic indicator. The close association between high tumor volume and HGCP su pports the theory that the development of HGCP is a late event in tumo r progression, more compatible with the intraductal spread of tumor th an dysplasia.