Related Experiment Video
Updated: May 14, 2026
Enhancing Prostate Tumor Biobanking Reliability with Improved Sampling Technique and Histological Characterization
Published on: November 17, 2023
Cribriform/Intraductal carcinoma exhibits superior prognostic value over Gleason pattern 4 percentage and tertiary
Chaojiang Chen1,2, Xiaoyang Liu1,3, Shulin Wu1,4
1Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Background:
In the absence of primary or secondary pattern 5, Gleason pattern 4 encompasses Gleason scores 3 + 4, 4 + 3, and 4 + 4 at radical prostatectomy (RP). The associated adverse pathological features, including Gleason pattern 4% (%GP4), cribriform/intraductal carcinoma (Crib/IDC), and tertiary pattern 5 (TP5), have become particularly important factors for improving postoperative risk stratification. However, few studies have simultaneously evaluated the prognostic significance of %GP4, Crib/IDC, and TP5 specifically within Gleason pattern 4 disease.
Objective:
To investigate the prognostic significance of %GP4, Crib/IDC and TP5 for biochemical recurrence (BCR) and metastasis in RP patients with Gleason pattern 4 disease.
Methods:
A retrospective cohort of RP patients with Gleason pattern 4 disease was identified from 2008 to 2014 at Massachusetts General Hospital. Pathological variables included %GP4, Crib/IDC, and TP5. Patients were stratified by these features to assess their prognostic impact. Cox proportional hazards models were applied to evaluate their prognostic associations with BCR and metastasis.
Results:
Among 559 RP patients with Gleason pattern 4 disease, 55.1% had %GP4 ≥ 50%, 49.0% were Crib/IDC-positive, and 12.3% exhibited TP5, with these three variables exhibiting clear interrelationships. All three adverse morphological features were associated with significantly worse BCR-free survival and metastasis-free survival (log-rank P < 0.001). In multivariable Cox regression, Crib/IDC demonstrated the strongest prognostic association, independently predicting an 80% increased risk of BCR (HR 1.80, 95% CI 1.35-2.40) and 90% increased risk of metastasis (HR 1.90, 95% CI 1.19-3.03). %GP4 remained a significant continuous predictor of both endpoints (HR 1.009 per 1% increase for BCR; HR 1.016 for metastasis), whereas TP5 retained significance as a predictor only for BCR (HR 1.47, 95% CI 1.04-2.06) but not for metastasis (HR 1.31, P = 0.298).
Conclusion:
%GP4, Crib/IDC, and TP5 were correlated and adverse features in RP patients with Gleason pattern 4 disease and were associated with worse oncologic outcomes. Crib/IDC demonstrated the strongest prognostic relevance, supporting consideration of standardized reporting beyond Gleason score alone.
