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Reporting Practices and Resource Utilization in the Era of Intraductal Carcinoma of the Prostate: A Survey of Genitourinary Subspecialists

JS. Gandhi, SC. Smith, GP. Paner, JK. McKenney, R. Sekhri, AO. Osunkoya, AS. Baras, AM. DeMarzo, JC. Cheville, RE. Jimenez, K. Trpkov, M. Colecchia, JY. Ro, R. Montironi, S. Menon, O. Hes, SR. Williamson, MS. Hirsch, GJ. Netto, SW. Fine, D....

. 2020 ; 44 (5) : 673-680. [pub] -

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc20025033

Intraductal carcinoma of the prostate (IDC-P) has been recently recognized by the World Health Organization classification of prostatic tumors as a distinct entity, most often occurring concurrently with invasive prostatic adenocarcinoma (PCa). Whether documented admixed with PCa or in its rare pure form, numerous studies associate this entity with clinical aggressiveness. Despite increasing clinical experience and requirement of IDC-P documentation in protocols for synoptic reporting, the specifics of its potential contribution to assessment of grade group (GG) and cancer quantitation of PCa in both needle biopsies (NBx) and radical prostatectomy (RP) specimens remain unclear. Moreover, there are no standard guidelines for incorporating basal cell marker immunohistochemistry (IHC) in the diagnosis of IDC-P, either alone or as part of a cocktail with AMACR/racemase. An online survey containing 26 questions regarding diagnosis, reporting practices, and IHC resource utilization, focusing on IDC-P, was undertaken by 42 genitourinary subspecialists from 9 countries. The degree of agreement or disagreement regarding approaches to individual questions was classified as significant majority (>75%), majority (51% to 75%), minority (26% to 50%) and significant minority (≤25%). IDC-P with or without invasive cancer is considered a contraindication for active surveillance by the significant majority (95%) of respondents, although a majority (66%) also agreed that the clinical significance/behavior of IDC-P on NBx or RP with PCa required further study. The majority do not upgrade PCa based on comedonecrosis seen only in the intraductal component in NBx (62%) or RP (69%) specimens. Similarly, recognizable IDC-P with GG1 PCa was not a factor in upgrading in NBx (78%) or RP (71%) specimens. The majority (60%) of respondents include readily recognizable IDC-P in assessment of linear extent of PCa at NBx. A significant majority (78%) would use IHC to confirm or exclude intraductal carcinoma if other biopsies showed no PCa, while 60% would use it to confirm IDC-P with invasive PCa in NBx if it would change the overall GG assignment. Nearly half (48%, a minority) would use IHC to confirm IDC-P for accurate Gleason pattern 4 quantitation. A majority (57%) report the percentage of IDC-P when present, in RP specimens. When obvious Gleason pattern 4 or 5 PCa is present in RP or NBx, IHC is rarely to almost never used to confirm the presence of IDC-P by the significant majority (88% and 90%, respectively). Most genitourinary pathologists consider IDC-P to be an adverse prognostic feature independent of the PCa grade, although recommendations for standardization are needed to guide reporting of IDC-P vis a vis tumor quantitation and final GG assessment. The use of IHC varies widely and is performed for a multitude of indications, although it is used most frequently in scenarios where confirmation of IDC-P would impact the GG assigned. Further study and best practices recommendations are needed to provide guidance with regards to the most appropriate indications for IHC use in scenarios regarding IDC-P.

All India Institute of Medical Sciences New Delhi India

ARUP Laboratories Salt Lake City UT

Brigham and Women's Hospital Boston MA

Charles University Medical Faculty Hospital Hradec Kralove Czech Republic Europe

Cleveland Clinic Cleveland OH

Department of Pathology and Laboratory Medicine Indiana University Indianapolis IN

Department of Pathology and Laboratory Medicine University of Calgary Calgary AB

Department of Pathology and Laboratory Medicine University of Tennessee Health Science Center Memphis TN

Department of Pathology Messejana Heart and Lung Hospital Fortaleza

Department of Pathology The University of Alabama at Birmingham Birmingham AL

Department of Pathology The University of Michigan Ann Arbor MI

Departments of Pathology and Surgery The University of Chicago Chicago IL

Departments of Pathology and Urology Virginia Commonwealth University Richmond VA

El Camino Hospital Mountain View

Emory University School of Medicine Atlanta GA

Erasmus Medical Center Rotterdam The Netherlands

Henry Ford Hospital Detroit MI

Houston Methodist Hospital Houston TX

Institute of Anatomic Pathology Piracicaba Brazil

IRCCS National Cancer Institute Milan

John Hopkins Hospital Baltimore MD

Keck School of Medicine University of Southern California Los Angeles CA

Kochi Red Cross Hospital Kochi Japan

Mayo Clinic Rochester MN

Memorial Sloan Kettering Cancer Center

Miller School of Medicine University of Miami Miami FL

Oregon Health and Science University Portland OR

Polytechnic University of the Marche Region School of Medicine United Hospitals Ancona Italy

Royal Prince Alfred Hospital Sydney NSW Australia

Tata Memorial Hospital Mumbai Maharashtra

University Health Network University of Toronto Toronto ON Canada

Weil Cornell Medical College New York City NY

Yale School of Medicine New Haven CT

References provided by Crossref.org

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$a Intraductal carcinoma of the prostate (IDC-P) has been recently recognized by the World Health Organization classification of prostatic tumors as a distinct entity, most often occurring concurrently with invasive prostatic adenocarcinoma (PCa). Whether documented admixed with PCa or in its rare pure form, numerous studies associate this entity with clinical aggressiveness. Despite increasing clinical experience and requirement of IDC-P documentation in protocols for synoptic reporting, the specifics of its potential contribution to assessment of grade group (GG) and cancer quantitation of PCa in both needle biopsies (NBx) and radical prostatectomy (RP) specimens remain unclear. Moreover, there are no standard guidelines for incorporating basal cell marker immunohistochemistry (IHC) in the diagnosis of IDC-P, either alone or as part of a cocktail with AMACR/racemase. An online survey containing 26 questions regarding diagnosis, reporting practices, and IHC resource utilization, focusing on IDC-P, was undertaken by 42 genitourinary subspecialists from 9 countries. The degree of agreement or disagreement regarding approaches to individual questions was classified as significant majority (>75%), majority (51% to 75%), minority (26% to 50%) and significant minority (≤25%). IDC-P with or without invasive cancer is considered a contraindication for active surveillance by the significant majority (95%) of respondents, although a majority (66%) also agreed that the clinical significance/behavior of IDC-P on NBx or RP with PCa required further study. The majority do not upgrade PCa based on comedonecrosis seen only in the intraductal component in NBx (62%) or RP (69%) specimens. Similarly, recognizable IDC-P with GG1 PCa was not a factor in upgrading in NBx (78%) or RP (71%) specimens. The majority (60%) of respondents include readily recognizable IDC-P in assessment of linear extent of PCa at NBx. A significant majority (78%) would use IHC to confirm or exclude intraductal carcinoma if other biopsies showed no PCa, while 60% would use it to confirm IDC-P with invasive PCa in NBx if it would change the overall GG assignment. Nearly half (48%, a minority) would use IHC to confirm IDC-P for accurate Gleason pattern 4 quantitation. A majority (57%) report the percentage of IDC-P when present, in RP specimens. When obvious Gleason pattern 4 or 5 PCa is present in RP or NBx, IHC is rarely to almost never used to confirm the presence of IDC-P by the significant majority (88% and 90%, respectively). Most genitourinary pathologists consider IDC-P to be an adverse prognostic feature independent of the PCa grade, although recommendations for standardization are needed to guide reporting of IDC-P vis a vis tumor quantitation and final GG assessment. The use of IHC varies widely and is performed for a multitude of indications, although it is used most frequently in scenarios where confirmation of IDC-P would impact the GG assigned. Further study and best practices recommendations are needed to provide guidance with regards to the most appropriate indications for IHC use in scenarios regarding IDC-P.
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$a Smith, Steven C $u Departments of Pathology and Urology, Virginia Commonwealth University, Richmond, VA.
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$a Paner, Gladell P $u Departments of Pathology and Surgery (Urology), The University of Chicago, Chicago, IL.
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