Rare Histological Variants of Prostate Adenocarcinoma: A National Cancer Database Analysis

No AccessJournal of UrologyAdult Urology1 Aug 2020Rare Histological Variants of Prostate Adenocarcinoma: A National Cancer Database AnalysisThis article is commented on by the following:Editorial CommentEditorial Comment Chandler Bronkema, Sohrab Arora, Akshay Sood, Deepansh Dalela, Jacob Keeley, Alex Borchert, Lee Baumgarten, Craig G. Rogers, James O. Peabody, Mani Menon, and Firas Abdollah Chandler BronkemaChandler Bronkema Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan , Sohrab AroraSohrab Arora Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Akshay SoodAkshay Sood Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Deepansh DalelaDeepansh Dalela Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Jacob KeeleyJacob Keeley Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Alex BorchertAlex Borchert Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Lee BaumgartenLee Baumgarten Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Craig G. RogersCraig G. Rogers Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , James O. PeabodyJames O. Peabody Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , Mani MenonMani Menon Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan , and Firas AbdollahFiras Abdollah Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan View All Author Informationhttps://doi.org/10.1097/JU.0000000000001011AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The American Joint Committee on Cancer recognizes 6 rare histological variants of prostate adenocarcinoma. We describe the contemporary presentation and overall survival of these rare variants. Materials and Methods: We examined 1,345,618 patients who were diagnosed with prostate adenocarcinoma between 2004 and 2015 within the National Cancer Database. We focused on the variants mucinous, ductal, signet ring cell, adenosquamous, sarcomatoid and neuroendocrine. Characteristics at presentation for each variant were compared with nonvariant prostate adenocarcinoma. Cox regression was used to study the impact of histological variant on overall mortality. Results: Few (0.38%) patients presented with rare variant prostate adenocarcinoma. All variants had higher clinical tumor stage at presentation than nonvariant (all p <0.001). Metastatic disease was most common with neuroendocrine (62.9%), followed by sarcomatoid (33.3%), adenosquamous (31.1%), signet ring cell (10.3%) and ductal (9.8%), compared to 4.2% in nonvariant (all p <0.001). Metastatic disease in mucinous (3.3%) was similar to nonvariant (p=0.2). Estimated 10-year overall survival was highest in mucinous (78.0%), followed by nonvariant (71.1%), signet ring cell (56.8%), ductal (56.3%), adenosquamous (20.5%), sarcomatoid (14.6%) and neuroendocrine (9.1%). At multivariable analysis, mortality was higher in ductal (HR 1.38, p <0.001), signet ring cell (HR 1.53, p <0.01), neuroendocrine (HR 5.72, p <0.001), sarcomatoid (HR 5.81, p <0.001) and adenosquamous (HR 9.34, p <0.001) as compared to nonvariant. Conclusions: Neuroendocrine, adenosquamous, sarcomatoid, signet ring cell and ductal variants more commonly present with metastases. All variants present with higher local stage than nonvariant. Neuroendocrine is associated with the worst and mucinous with the best overall survival. References 1. : SEER Cancer Statistics Review 1975-2016. National Cancer Institute; 2019. Available at https://seer.cancer.gov/csr/1975_2016/. Google Scholar 2. : Histological variants of prostatic carcinoma and their significance. Histopathology 2012; 60: 59. Google Scholar 3. : Update on prostate pathology. Pathology 2012; 44: 391. Google Scholar 4. : AJCC cancer staging manual. JAMA 2010; 304: 1726. 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Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 395 and 396. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology21 May 2020Editorial CommentJournal of Urology21 May 2020Editorial Comment Volume 204Issue 2August 2020Page: 260-266Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordssurvivalrare diseasesprostatic neoplasmsMetricsAuthor Information Chandler Bronkema Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan More articles by this author Sohrab Arora Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Akshay Sood Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Deepansh Dalela Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Jacob Keeley Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Alex Borchert Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Lee Baumgarten Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Craig G. Rogers Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author James O. Peabody Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Mani Menon Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Firas Abdollah Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 395 and 396. Advertisement PDF downloadLoading ...