title: Not all gleason pattern 4 prostate cancers are created equal: A study of latent prostatic carcinomas in a cystoprostatectomy and autopsy series.
abstract: BACKGROUND
  The Gleason grading system represents the cornerstone of the management of prostate cancer. Gleason grade 4 (G4) is a heterogeneous set of architectural patterns, each of which may reflect a distinct prognostic value.
  
  
  METHODS
  We determined the prevalence of the various G4 architectural patterns and intraductal carcinoma (IDC) in latent prostate cancer in contemporary Russian (n = 220) and Japanese (n = 100) autopsy prostates and in cystoprostatectomy (CP) specimens (n = 248) collected in Italy. We studied the association of each G4 pattern with extraprostatic extension (EPE) and tumor volume to gain insight into their natural history. Presence of IDC and nine architectural features of Gleason grade 4 and 5 cancer were recorded.
  
  
  RESULTS
  The prevalence of Gleason score ≥ 7 PC was higher in the autopsy series (11%) compared to the CP series (6.5%, P = 0.04). The prevalence of IDC and carcinoma with a cribriform architecture was 2.2% and 3.4% in the autopsy series and 0.8% and 3.6% in the cystoprostatectomy series, respectively. In multivariable analysis, cribriform architecture was significantly associated with increased tumor volume (P < 0.001) and EPE (OR:11.48, 95%CI:2.30-57.16, P = 0.003). IDC was also significantly associated with EPE (OR:10.08, 95%CI:1.58-64.28, P = 0.014). Small fused glands had a strong negative association with EPE in the autopsy series (OR:0.06, 95%CI:0.01-0.58, P = 0.015).
  
  
  CONCLUSIONS
  Our study revealed that in latent prostate cancer both cribriform architecture and IDC are uniquely associated with poor pathological outcome features. In contrast, Gleason score 7 (3 + 4) cancers with small-fused gland pattern might possibly include some prostate cancers with a more indolent biology.
authors.affiliation: Department of Anatomical Pathology, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
authors.forename: Farshid
authors.initials: F
authors.lastname: Siadat
authors.affiliation: Biostatistics, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
authors.forename: Jenna
authors.initials: J
authors.lastname: Sykes
authors.affiliation: Department of Surgery, Division of Urology, Mount Sinai Hospital and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Zlotta
authors.affiliation: Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Najla
authors.initials: N
authors.lastname: Aldaoud
authors.affiliation: Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Egawa
authors.affiliation: Department of Urology, University of Moscow, Moscow, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Pushkar
authors.affiliation: Department of Surgery, Division of Urology, Mount Sinai Hospital and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kuk
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Bristow
authors.affiliation: Institute of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.affiliation: Department of Laboratory Medicine and Pathology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Theodorus
authors.initials: T
authors.lastname: van der Kwast
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001344:Autopsy; D044584:Carcinoma, Ductal / Q000473:pathology*; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D007564:Japan; D008297:Male; D060787:Neoplasm Grading; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012426:Russia
keywords: Gleason grading; cribriform architecture; intraductal carcinoma; latent cancer; prostate