Carcinome intracanalaire de la prostate

Virchows Arch. 2026 May 12. doi: 10.1007/s00428-026-04571-6. Online ahead of print.ABSTRACTHistopathological grading remains the cornerstone of risk stratification in prostate cancer, yet conventional Gleason-based assessment is limited by interobserver variability and by the biological heterogeneity concealed within Gleason pattern 4. This review examines the evolution of prostate cancer grading from the original Gleason system to contemporary Grade Groups and to newer morphology-based frameworks that seek to refine prognostic stratification. Particular attention is given to the distinction between patterns 3 and 4, which remains clinically pivotal but diagnostically challenging, especially in the setting of poorly formed glands. By contrast, cribriform architecture has emerged as one of the most reproducible and prognostically adverse components of pattern 4. Intraductal carcinoma of the prostate (IDC-P), which often overlaps morphologically and biologically with cribriform carcinoma, is similarly associated with aggressive disease and is now addressed within a more unified diagnostic and grading framework following the recent joint GUPS/ISUP recommendations. Outcome-based morphometric studies further suggest that a diameter threshold of approximately 0.25 mm can identify large cribriform glands with particularly adverse behavior, although standardization remains incomplete. These observations have contributed to the development of a risk-oriented taxonomy in which adverse architectural features may carry greater prognostic weight than numerical grade alone. Finally, we discuss how digital pathology and artificial intelligence are extending this conceptual shift by improving diagnostic reproducibility, enabling quantitative detection of cribriform morphology and supporting outcome-oriented histology-based risk prediction. Together, these developments suggest that prostate cancer grading is moving from a purely descriptive system toward a more integrated and biologically informed model of risk assessment.PMID:42115324 | DOI:10.1007/s00428-026-04571-6

World J Urol. 2026 May 12;44(1):355. doi: 10.1007/s00345-026-06450-w.ABSTRACTBACKGROUND: In the absence of primary or secondary pattern 5, Gleason pattern 4 encompasses Gleason scores 3 + 4, 4 + 3, and 4 + 4 at radical prostatectomy (RP). The associated adverse pathological features, including Gleason pattern 4% (%GP4), cribriform/intraductal carcinoma (Crib/IDC), and tertiary pattern 5 (TP5), have become particularly important factors for improving postoperative risk stratification. However, few studies have simultaneously evaluated the prognostic significance of %GP4, Crib/IDC, and TP5 specifically within Gleason pattern 4 disease.OBJECTIVE: To investigate the prognostic significance of %GP4, Crib/IDC and TP5 for biochemical recurrence (BCR) and metastasis in RP patients with Gleason pattern 4 disease.METHODS: A retrospective cohort of RP patients with Gleason pattern 4 disease was identified from 2008 to 2014 at Massachusetts General Hospital. Pathological variables included %GP4, Crib/IDC, and TP5. Patients were stratified by these features to assess their prognostic impact. Cox proportional hazards models were applied to evaluate their prognostic associations with BCR and metastasis.RESULTS: Among 559 RP patients with Gleason pattern 4 disease, 55.1% had %GP4 ≥ 50%, 49.0% were Crib/IDC-positive, and 12.3% exhibited TP5, with these three variables exhibiting clear interrelationships. All three adverse morphological features were associated with significantly worse BCR-free survival and metastasis-free survival (log-rank P < 0.001). In multivariable Cox regression, Crib/IDC demonstrated the strongest prognostic association, independently predicting an 80% increased risk of BCR (HR 1.80, 95% CI 1.35-2.40) and 90% increased risk of metastasis (HR 1.90, 95% CI 1.19-3.03). %GP4 remained a significant continuous predictor of both endpoints (HR 1.009 per 1% increase for BCR; HR 1.016 for metastasis), whereas TP5 retained significance as a predictor only for BCR (HR 1.47, 95% CI 1.04-2.06) but not for metastasis (HR 1.31, P = 0.298).CONCLUSION: %GP4, Crib/IDC, and TP5 were correlated and adverse features in RP patients with Gleason pattern 4 disease and were associated with worse oncologic outcomes. Crib/IDC demonstrated the strongest prognostic relevance, supporting consideration of standardized reporting beyond Gleason score alone.PMID:42120740 | DOI:10.1007/s00345-026-06450-w