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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. © 2021 College of American Pathologists.

Citation

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. The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer. Archives of pathology & laboratory medicine. 2021 Apr 01;145(4):461-493

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PMID: 32589068

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