Prostate Cancer Grading : An Update - 18/11/25

Doi : 10.1016/j.ucl.2025.09.003

John Hanna, MD ^a, Gennady Bratslavsky, MD ^b, Liang Cheng, MD, MS ^c,^d, Jeffrey S. Ross, MD ^a,^b,^e, Oleksandr Kravtsov, MD ^a,^⁎

^a Department of Pathology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA

^b Department of Urology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA

^c Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, The Legorreta Cancer Center at Brown University, and Brown University Health, 70 Ship Street, Providence, RI 02903, USA

^d Department of Surgery (Urology), Brown University Warren Alpert Medical School, The Legorreta Cancer Center at Brown University, and Brown University Health, 70 Ship Street, Providence, RI 02903, USA

^e Department Medicine (Oncology) SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA

^∗ Corresponding author.

Résumé

Recent changes in grading guidelines include the adoption of grade groups, reporting of percentage of pattern 4, reporting of intraductal carcinoma, and presence of cribriform pattern, making pathology reports more prognostically accurate and less confusing. However, pathologists in their daily practice still face challenges related to the subjective nature of identification of cancer growth patterns and difficulties related to tangential sectioning, leading to high intra- and interobserver variability of prostate cancer grades in some cases. Reporting and grading small cancer areas, reporting tertiary Gleason patterns, and precise identification and grading of intraductal carcinoma all remain problematic areas of prostate pathology.

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Keywords : Prostate cancer grading, Gleason grade groups, Intraductal carcinoma, Atypical intraductal proliferation