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Historical and contemporary perspectives on cribriform morphology in prostate cancer

Nature Reviews Urology volume 15, pages 475–482 (2018)Cite this article

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Abstract

The Gleason scoring system is widely used for the grading and prognostication of prostate cancer. A Gleason pattern 4 subtype known as cribriform morphology has now been recognized as an aggressive and often lethal pattern of prostate cancer. The vast majority of published and ongoing prostate cancer studies still do not acknowledge the prognostic differences between various Gleason pattern 4 morphologies. As a result, current treatment recommendations are likely to be imprecise and not tailored towards patients who are most likely to die from the disease. Use of active surveillance for patients with Gleason score 3 + 4 prostate cancer has been suggested. However, the success of such paradigms would require cribriform morphology to be reported at the time of prostate biopsy, as patients harbouring such a pattern are poor candidates for surveillance. To date, only a limited number of studies have described the molecular alterations that occur in the cribriform morphological pattern. Further refinement of prostate cancer grading paradigms to distinguish cribriform from noncribriform Gleason pattern 4 is essential.

Key points

  • Optimizing the detection and treatment of lethal prostate cancer is critical.

  • The Gleason scoring system is the most widely used pathological grading system for characterizing prostate cancer aggressiveness.

  • Gleason pattern 4 consists of four distinct morphological subtypes — fused, poorly formed, cribriform, and glomeruloid.

  • Cribriform morphology is now recognized as the most aggressive Gleason pattern 4 subtype.

  • Molecular alterations in cribriform tumours have been observed and might explain the aggressiveness of this subtype.

  • Although not yet mandatory, the routine reporting of cribriform morphology on pathological biopsy reports should be highly encouraged.

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Fig. 1: Gleason pattern 4 morphologies.
Fig. 2: Prostate cancer studies showing the aggressive nature of cribriform morphology.

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Reviewer information

Nature Reviews Urology thanks R. Montironi, G. Netto, and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Department of Urology, University of Rochester Medical Center, Rochester, NY, USA

    Matthew Truong, Thomas Frye, Edward Messing & Hiroshi Miyamoto

  2. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Edward Messing & Hiroshi Miyamoto

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All authors contributed to researching data for the article, discussion of content, writing the article, and review and editing of the manuscript before submission.

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Correspondence to Hiroshi Miyamoto.

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PubMed and Embase searches were conducted using the following search terms: “prostate cancer” and “cribriform”; and “cribriform” and “Gleason.” A total of 401 unique results were identified. Abstracts were reviewed, and appropriate English-language peer-reviewed full-text articles were extracted for more comprehensive review. Initially, selected articles involved histological evaluation of prostate cancer for cribriform morphology, prostate cancer prognostication based on cribriform morphology, treatment of prostate cancer containing cribriform morphology, or biomolecular studies involving prostate tumours containing cribriform morphology. The final articles selected for inclusion were those considered to have a good quality of evidence and high relevance according to mutual agreement by the authors.

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Truong, M., Frye, T., Messing, E. et al. Historical and contemporary perspectives on cribriform morphology in prostate cancer. Nat Rev Urol 15, 475–482 (2018). https://doi.org/10.1038/s41585-018-0013-1

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