“Pathology of Prostate Cancer”

Dr Michelle Downes MD FRCPC, Urologic Pathologist

Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto

Laboratory Medicine and Pathobiology, University of Toronto

Financial Disclosures

Advisory board member for PDL-1 testing/implementation for Hoffman-La Roche and

Astra Zeneca

Conflicts of Interest

None to declare

Overview

• Gleason Grading

• ISUP grade groups

• Intraductal carcinoma & cribriform architecture carcinomas

Dr Donald F. GleasonUniversity of Minnesota, VA Medical CenterMinneapolis

Gleason DF. Classification of Prostatic Carcinomas. Cancer Chemother Rep 1966; 50:125-128.

2005 ISUP Modifications

Small cribriform glands: previously pattern 3 now pattern 4

2014 ISUP Modified Gleason System

Cribriform should ALL be considered pattern 4

Glomeruloid glands should be considered pattern 4

Mucinous carcinomas graded on architectural pattern

Intraductal carcinoma is not graded

Mucinous carcinoma: previously pattern 4 now pattern 3

AJSP 2016; 2:244-252

Gleason Grading 2017…..

2014 modified ISUPGleason schematic

Original Gleason schematic

Main change is the Gleason grade 3 and 4 groups.

AJSP 2016; 2:244-252

Gleason 4 patterns

ISUP Grade Groups

• 5 tiered grading prognostic system (1-5)

• >7,800 radical prostatectomy cases

ISUP Grade Groups 1-5GS 6

GS 7 (3+4)

GS 7 (4+3)

GS 8

GS 9-10

Reporting % 4/5 pattern

Intraductal Carcinoma

• ~ 20% of radical prostatectomies

• Associated with– ↑ Tumour volume

– ↑ Stage

– ↑ Gleason score

– + Surgical margins

• Independent prognosticfactor

Cribriform Architecture

• More frequent in men with nodal metastasis

• Associated with biochemical recurrence

Intraductal Carcinoma and Cribriform Architecture Carcinoma

Frequently associated with each other

Large Cribriform Intraductal Carcinoma

Cribriform Gleason Pattern 4- May occur concurrently with IDC-P

- Associated with biochemical recurrence

- Seen more frequently in radical prostatectomies with lymph node mets

Patients with CR/IDC on biopsy associated with worse disease specific survival

Gleason 7/10 with no CR/IDC have similar BCRFS as Gleason score 6/10

% 4/5

Intraductal carcinoma

Cribriform architecture

Sunnybrook Synoptic Report for Prostate Biopsy

Thank You!

www.isupweb.org