Practice patterns related to prostate cancer grading: results of a 2019 Genitourinary Pathology Society clinician survey

Urol Oncol. 2021 May;39(5):295.e1-295.e8. doi: 10.1016/j.urolonc.2020.08.027. Epub 2020 Sep 15.

Abstract

Purpose: To survey urologic clinicians regarding interpretation of and practice patterns in relation to emerging aspects of prostate cancer grading, including quantification of high-grade disease, cribriform/intraductal carcinoma, and impact of magnetic resonance imaging-targeted needle biopsy.

Materials and methods: The Genitourinary Pathology Society distributed a survey to urology and urologic oncology-focused societies and hospital departments. Eight hundred and thirty four responses were collected and analyzed using descriptive statistics.

Results: Eighty percent of survey participants use quantity of Gleason pattern 4 on needle biopsy for clinical decisions, less frequently with higher Grade Groups. Fifty percent interpret "tertiary" grade as a minor/<5% component. Seventy percent of respondents would prefer per core grading as well as a global/overall score per set of biopsies, but 70% would consider highest Gleason score in any single core as the grade for management. Seventy five percent utilize Grade Group terminology in patient discussions. For 45%, cribriform pattern would affect management, while for 70% the presence of intraductal carcinoma would preclude active surveillance.

Conclusion: This survey of practice patterns in relationship to prostate cancer grading highlights similarities and differences between contemporary pathology reporting and its clinical application. As utilization of Gleason pattern 4 quantification, minor tertiary pattern, cribriform/intraductal carcinoma, and the incorporation of magnetic resonance imaging-based strategies evolve, these findings may serve as a basis for more nuanced communication and guide research efforts involving pathologists and clinicians.

Keywords: Active surveillance; Cribriform; Grading; MRI; Prostate cancer.

MeSH terms

  • Health Surveys
  • Humans
  • Image-Guided Biopsy
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Grading
  • Practice Patterns, Physicians'*
  • Prostatic Neoplasms / diagnostic imaging
  • Prostatic Neoplasms / pathology*
  • Urology*