The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer.

Journal Article (Journal Article;Review)

CONTEXT.—: Controversies and uncertainty persist in prostate cancer grading. OBJECTIVE.—: To update grading recommendations. DATA SOURCES.—: Critical review of the literature along with pathology and clinician surveys. CONCLUSIONS.—: 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.

Full Text

Duke Authors

Cited Authors

  • Epstein, JI; Amin, MB; Fine, SW; Algaba, F; Aron, M; Baydar, DE; Beltran, AL; Brimo, F; Cheville, JC; Colecchia, M; Comperat, E; da Cunha, IW; Delprado, W; DeMarzo, AM; Giannico, GA; Gordetsky, JB; Guo, CC; Hansel, DE; Hirsch, MS; Huang, J; Humphrey, PA; Jimenez, RE; Khani, F; Kong, Q; Kryvenko, ON; Kunju, LP; Lal, P; Latour, M; Lotan, T; Maclean, F; Magi-Galluzzi, C; Mehra, R; Menon, S; Miyamoto, H; Montironi, R; Netto, GJ; Nguyen, JK; Osunkoya, AO; Parwani, A; Robinson, BD; Rubin, MA; Shah, RB; So, JS; Takahashi, H; Tavora, F; Tretiakova, MS; True, L; Wobker, SE; Yang, XJ; Zhou, M; Zynger, DL; Trpkov, K

Published Date

  • April 1, 2021

Published In

Volume / Issue

  • 145 / 4

Start / End Page

  • 461 - 493

PubMed ID

  • 32589068

Electronic International Standard Serial Number (EISSN)

  • 1543-2165

Digital Object Identifier (DOI)

  • 10.5858/arpa.2020-0015-RA


  • eng

Conference Location

  • United States