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

TY - JOUR

T1 - 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

AU - Marra, Giancarlo

AU - van Leenders, Geert J L H

AU - Zattoni, Fabio

AU - Kesch, Claudia

AU - Rajwa, Pawel

AU - Cornford, Philip

AU - van der Kwast, Theodorus

AU - van den Bergh, Roderick C N

AU - Briers, Erik

AU - Van den Broeck, Thomas

AU - De Meerleer, Gert

AU - De Santis, Maria

AU - Eberli, Daniel

AU - Farolfi, Andrea

AU - Gillessen, Silke

AU - Grivas, Nikolaos

AU - Grummet, Jeremy P

AU - Henry, Ann M

AU - Lardas, Michael

AU - Lieuw, Matt

AU - Linares Espinós, Estefania

AU - Mason, Malcolm D

AU - O'Hanlon, Shane

AU - van Oort, Inge M

AU - Oprea-Lager, Daniela E

AU - Ploussard, Guillaume

AU - Rouvière, Olivier

AU - Schoots, Ivo G

AU - Stranne, Johan

AU - Tilki, Derya

AU - Wiegel, Thomas

AU - Willemse, Peter-Paul M

AU - Mottet, Nicolas

AU - Gandaglia, Giorgio

AU - European Association of Urology Young Academic Urologists Prostate Cancer Working Group, the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines Panel on Prostate Cancer

N1 - Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2023/7

Y1 - 2023/7

N2 - CONTEXT: The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed.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.

AB - CONTEXT: The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed.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.

KW - Humans

KW - Male

KW - Prostate/surgery

KW - Prostate-Specific Antigen

KW - Prostatectomy

KW - Prostatic Intraepithelial Neoplasia

KW - Prostatic Neoplasms/pathology

U2 - 10.1016/j.eururo.2023.03.014

DO - 10.1016/j.eururo.2023.03.014

M3 - SCORING: Journal article

C2 - 37117107

VL - 84

SP - 65

EP - 85

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 1

ER -