{
  "abstract": "Aims Pre-surgical risk classification tools for prostate cancer have shown better patient stratification with the addition of cribriform pattern 4 (CC) and intraductal prostatic carcinoma (IDC) identified in biopsies. Here, we analyse the additional prognostic impact of CC/IDC observed in prostatectomies using Cancer of Prostate Risk Assessment post-surgical (CAPRA-S) stratification.Methods A retrospective cohort of treatment-naïve radical prostatectomy specimens from three North American academic institutions (2010–2018) was assessed for the presence of CC/IDC. Patients were classified, after calculating the CAPRA-S scores, into low-risk (0–2), intermediate-risk (3–5) and high-risk (6–12) groups. Kaplan-Meier curves were created to estimate biochemical recurrence (BCR)-free survival. Prognostic performance was examined using Harrell’s concordance index, and the effects of CC/IDC within each risk group were evaluated using the Cox proportional hazards models.Results Our cohort included 825 prostatectomies (grade group (GG)1, n=94; GG2, n=475; GG3, n=185; GG4, n=13; GG5, n=58). CC/IDC was present in 341 (41%) prostatectomies. With a median follow-up of 4.2 years (range 2.9–6.4), 166 (20%) patients experienced BCR. The CAPRA-S low-risk, intermediate-risk and high-risk groups comprised 357 (43%), 328 (40%) and 140 (17%) patients, and discriminated for BCR-free survival (p<0.0001). For CAPRA-S scores 3–5, the addition of CC/IDC status improved stratification for BCR (HR 2.27, 95% CI 1.41 to 3.66, p<0.001) and improved the overall c-index (0.689 vs 0.667, analysis of variance p<0.001).Conclusion The addition of CC/IDC into the CAPRA-S classification significantly improved post-radical prostatectomy patient stratification for BCR among the intermediate-risk group (CAPRA-S scores 3–5). The reporting of CC and IDC should be included in future prostate cancer stratification tools for improved outcome prediction.",
  "authors": [
    {
      "affiliations": [
        "Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Ngoc-Nhu Jennifer Nguyen"
    },
    {
      "affiliations": [
        "Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA"
      ],
      "name": "Kristen Liu"
    },
    {
      "affiliations": [
        "Department of Biostatistics, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Katherine Lajkosz"
    },
    {
      "affiliations": [
        "Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA"
      ],
      "name": "Kenneth A Iczkowski"
    },
    {
      "affiliations": [
        "Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada",
        "Department of Pathology, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Theodorus H van der Kwast"
    },
    {
      "affiliations": [
        "Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada",
        "Department of Anatomic Pathology, Precision Diagnostics & Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Michelle R Downes"
    }
  ],
  "title": "Addition of cribriform pattern 4 and intraductal prostatic carcinoma into the CAPRA-S tool improves post-radical prostatectomy patient stratification in a multi-institutional cohort",
  "uid": "f975a9d8-4ee5-5d2e-ad96-deab44086be9"
}