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Exploring the metastatic potential of isolated tumour cells and clusters-cords patterns of ISUP Grade 5 acinar adenocarcinoma of the prostate: a comprehensive morphological analysis

  • 0Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini, 4 - 20072, Pieve Emanuele, Milan, Italy.
Virchows Archiv : an International Journal of Pathology +

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September 3, 2025

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September 3, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Gleason pattern 5 in prostate cancer shows distinct subtypes. Isolated single tumor cells/clusters and cords (ISTC/CC) are less common in metastases, suggesting a different metastatic potential compared to other patterns.

Area Of Science

  • Urology
  • Oncology
  • Pathology

Background

  • Gleason pattern 5 (GP5) in prostatic adenocarcinoma (PC) presents diverse morphologies, including undifferentiated solid (US), cribriform with necrosis (CN), clusters and cords (CC), and isolated single tumor cells (ISTC).
  • The prognostic significance of these GP5 subtypes in metastatic prostate cancer remains unclear.

Purpose Of The Study

  • To compare the distribution of GP5 subtypes in primary tumors with matched nodal and distant metastases.
  • To investigate the potential role of different GP5 morphologies in prostate cancer metastasis.

Main Methods

  • Retrospective histological analysis of 88 cases with nodal metastases (N1) and 70 without (N0) ISUP Grade Group 5 PC.
  • Analysis of 51 distant metastatic PC samples.
  • Quantification of GP5 subtypes (US, CN, CC, ISTC) in primary tumors, lymph nodes, and distant metastases.

Main Results

  • GP5 was present in 32% of nodal metastases, with US (18%) and CN (10%) being most frequent.
  • ISTC/CC patterns in primary tumors (79/88 patients) were significantly underrepresented in nodal metastases (14%, p < 0.00001).
  • Cribriform (CR) pattern dominated lymph nodes (87%), while US predominated in distant metastases (53%); ISTC/CC were rare (12%) in distant sites.

Conclusions

  • The low prevalence of ISTC/CC in metastatic sites suggests a potentially lower metastatic potential compared to CR or US patterns.
  • Environmental factors may also influence the development of ISTC/CC in metastases.
  • Findings support reconsidering the classification and prognostic role of ISTC/CC within GP5 in prostate cancer.

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