Cribriform carcinoma of the prostate, as aggressive as it sounds? A narrative review from the EAU section of endourology.

Abstract

Purpose of review: The management of localized prostate cancer (PCa) is shifting towards tissue-preserving strategies such as active surveillance and focal therapies. Intermediate-risk PCa, especially ISUP Grade Group 2 (GG2), encompasses a heterogeneous disease spectrum, complicating patient selection for conservative treatments. Cribriform architecture, a Gleason pattern 4 subtype, is associated with poorer outcomes and currently contraindicates active surveillance However, these conclusions are mainly based on retrospective data from older cohorts, raising questions about cribriform's independent prognostic value versus Gleason pattern 4 burden.

Recent findings: Cribriform pattern correlates strongly with increased Gleason pattern 4, which is linked to adverse features such as biochemical recurrence and tumour upstaging. The independent impact of cribriform remains unclear due to limited regression analyses and variable reporting. Cribriform detection on biopsy and MRI is challenging, often leading to underestimation and complicating risk stratification.

Summary: Despite current guidelines excluding cribriform-positive patients from active surveillance, emerging evidence suggests some patients with limited cribriform and low Gleason 4 percentage could be candidates for active surveillance or focal therapies. Prospective studies with standardized cribriform quantification and imaging evaluation are needed to clarify these issues.