Distinct Adverse Clinical Outcomes of Small and Large Cribriform Patterns on Gleason 7 Prostate Cancer: A Preliminary Study.

Objective: We aimed to evaluate the effect of large and small cribriform morphology on survival following radical prostatectomy.

Methods: We included 30 patients who underwent radical prostatectomy with curative intent between 2015 and 2022. Patients with the final pathology of Gleason 7 were included. Patients' radical prostatectomy specimens were reviewed by an experienced genitourinary pathologist. The diverse growth patterns of Gleason grade 4 were specified as poorly formed/fused glands, cribriform glands, and glomeruloid glands. The cribriform morphology was subdivided into small and large cribriform. Large cribriform growth morphology was defined by its size, which was double that of benign prostate glands. Small and large cribriform glands' percentages were indicated semiquantitatively. The cribriform morphology subtype present at 50% and higher was defined as the dominant pattern. The effect of histopathological patterns on biochemical recurrence and clinical progression was analyzed.

Results: Thirteen patients were small cribriform pattern dominant (group 1), whereas 14 of the patients were large cribriform pattern dominant (group 2). Pathological T, N stages, and surgical margin positivity were similar between groups. Biochemical recurrence and clinical progression rates were significantly higher in group 2. The large cribriform dominant patients had worse 2-year biochemical recurrence-free survival than small cribriform dominant patients (45.5% vs. 66.7%). In the univariate analysis, International Society of Urological Pathology grade, Gleason pattern 4 percentage, large cribriform pattern dominancy, and pT stage were predictors for biochemical recurrence-free survival. International Society of Urological Pathology grade was the only independent predictor for biochemical recurrence-free survival.

Conclusion: Large cribriform pattern dominancy is associated with worse biochemical recurrence-free survival in Gleason 7 prostate cancer.