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Association Between Cribriform Architecture and Tertiary Gleason Pattern 5 in Prostate Cancer: A Cross-Sectional
Sayeh Fattahi1, Yetkin Tuac2, Okan Argun1
1Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
Journal of Clinical Medicine
|June 26, 2026
Summary
Cribriform architecture, a feature of prostate cancer, is strongly linked to tertiary Gleason pattern 5. This finding suggests cribriform-positive tumors may indicate more aggressive cancer biology.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Cribriform architecture is an adverse Gleason pattern 4 morphology linked to aggressive prostate cancer.
- Tertiary Gleason pattern 5 may indicate higher-grade tumor biology beyond conventional grading.
Purpose of the Study:
- To investigate the association between cribriform architecture and tertiary Gleason pattern 5 in prostate cancer patients undergoing radical prostatectomy.
Main Methods:
- Retrospective cross-sectional study of 303 radical prostatectomy specimens.
- Centralized pathology review of digitized slides for cribriform architecture assessment.
- Analysis of original pathology reports for tertiary Gleason pattern 5 status.
- Multivariable logistic regression to assess the association, adjusting for clinical and pathological variables.
Main Results:
- 47 (15.5%) patients had tertiary Gleason pattern 5.
- Cribriform architecture was significantly more common in tumors with tertiary Gleason pattern 5 (70% vs. 21%, p < 0.001).
- Cribriform architecture remained independently associated with tertiary Gleason pattern 5 (aOR 9.46, p < 0.001).
Conclusions:
- Cribriform architecture shows a strong association with tertiary Gleason pattern 5 in prostate cancer.
- This suggests cribriform-positive tumors may harbor minor high-grade Gleason pattern 5 components, indicating more aggressive disease.
