Controversies and uncertainty persist in prostate cancer grading.
To update grading recommendations.
Critical review of the literature along with pathology and clinician surveys.
Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 + 4 = 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace "tertiary grade pattern" in radical prostatectomy (RP) with "minor tertiary pattern 5 (TP5)," and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)-targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 + 5 = 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (>50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) "atypical intraductal proliferation (AIP)" is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.
Archives of pathology & laboratory medicine. 2020 Jun 26 [Epub ahead of print]
Jonathan I Epstein, Mahul B Amin, Samson W Fine, Ferran Algaba, Manju Aron, Dilek E Baydar, Antonio Lopez Beltran, Fadi Brimo, John C Cheville, Maurizio Colecchia, Eva Comperat, Isabela Werneck da Cunha, Warick Delprado, Angelo M DeMarzo, Giovanna A Giannico, Jennifer B Gordetsky, Charles C Guo, Donna E Hansel, Michelle S Hirsch, Jiaoti Huang, Peter A Humphrey, Rafael E Jimenez, Francesca Khani, Qingnuan Kong, Oleksandr N Kryvenko, L Priya Kunju, Priti Lal, Mathieu Latour, Tamara Lotan, Fiona Maclean, Cristina Magi-Galluzzi, Rohit Mehra, Santosh Menon, Hiroshi Miyamoto, Rodolfo Montironi, George J Netto, Jane K Nguyen, Adeboye O Osunkoya, Anil Parwani, Brian D Robinson, Mark A Rubin, Rajal B Shah, Jeffrey S So, Hiroyuki Takahashi, Fabio Tavora, Maria S Tretiakova, Lawrence True, Sara E Wobker, Ximing J Yang, Ming Zhou, Debra L Zynger, Kiril Trpkov
From the Departments of Pathology (Drs Epstein, DeMarzo, and Lotan), Urology (Dr Epstein), and Oncology (Dr Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis (Dr Amin); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Fine); Department of Pathology, Fundacio Puigvert, Barcelona, Spain (Dr Algaba); Department of Pathology, University of Southern California, Los Angeles (Dr Aron); Department of Pathology, Faculty of Medicine, Koç University, İstanbul, Turkey (Dr Baydar); Department of Pathology, Champalimaud Centre for the Unknown, Lisbon, Portugal (Dr Beltran); Department of Pathology, McGill University Health Center, Montréal, QC, Canada (Dr Brimo); Department of Pathology, Mayo Clinic, Rochester, Minnesota (Drs Cheville and Jimenez); Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (Dr Colecchia); Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France (Dr Comperat); Pathology Department, Rede D'OR-Sao Luiz, Sao Paulo, SP, Brazil (Dr da Cunha); Douglass Hanly Moir Pathology, Sydney, Australia (Dr Delprado); Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Drs Giannico and Gordetsky); Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Guo); Department of Pathology, Oregon Health and Science University, Portland (Dr Hansel); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Hirsch); Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Dr Huang); Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Dr Humphrey); Department of Pathology and Laboratory Medicine and Urology, Weill Cornell Medicine, New York, New York (Drs Khani and Robinson); Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong, China (Dr Kong); Departments of Pathology and Laboratory Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (Dr Kryvenko); Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (Drs Kunju and Mehra); Perelman School of Medicine, University of Pennsylvania, Philadelphia (Dr Lal); Department of Pathology, CHUM, Université de Montréal, Montréal, QC, Canada (Dr Latour); Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia (Dr Maclean); Department of Pathology, The University of Alabama at Birmingham, Birmingham (Drs Magi-Galluzzi and Netto); Department of Surgical Pathology, Tata Memorial Hospital, Parel, Mumbai, India (Dr Menon); Departments of Pathology and Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York (Dr Miyamoto); Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy (Dr Montironi); Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Dr Nguyen); Department of Pathology, Emory University School of Medicine, Atlanta, Georgia (Dr Osunkoya); Department of Pathology, Ohio State University, Columbus (Drs Parwani and Zynger); Department for BioMedical Research, University of Bern, Bern, Switzerland (Dr Rubin); Department of Pathology, The University of Texas Southwestern Medical Center, Dallas (Dr Shah); Institute of Pathology, St Luke's Medical Center, Quezon City and Global City, Philippines (Dr So); Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan (Dr Takahashi); Argos Laboratory, Federal University of Ceara, Fortaleza, Brazil (Dr Tavora); Department of Pathology, University of Washington School of Medicine, Seattle (Drs Tretiakova and True); Departments of Pathology and Laboratory Medicine and Urology, University of North Carolina, Chapel Hill (Dr Wobker); Department of Pathology, Northwestern University, Chicago, Illinois (Dr Yang); Department of Pathology, Tufts Medical Center, Boston, Massachusetts (Dr Zhou); and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada (Dr Trpkov). Dr Kong is currently located at Kaiser Permanente Sacramento Medical Center, Sacramento, California.