Ma C, Downes M, Jain R, et al. - Researchers investigated the frequency of the recently established adverse histopathology features (cribriform pattern and intraductal carcinoma) in grade group [GG] 2 radical prostatectomies with syn or metachronous metastatic disease in order to validate the relevance of these features as contra-indication for deferred treatment of Gleason score 7 (3 + 4) (GG 2) prostate cancer.

• From a clinical database of a tertiary care center, researchers retrieved 1,860 GG2 prostatectomy specimens (operated between 2002 and 2020), concurrent regional lymph node metastases or distant metastases at follow-up were observed in 45 (2.4%) specimens.

• Nearly 90% of GG2 prostate cancers with local or distant metastatic disease had well-established unfavorable histopathologic features (intraductal and cribriform pattern carcinoma, ductal adenocarcinoma) and those without metastatic disease much less commonly had these features (38%).

• Strikingly, nearly 25% of GG2 prostatectomy cases with metastatic disease showed an organ-confined disease and/or a small percentage of Gleason grade 4 pattern.

• The relative relevance of these adverse histopathological features (cribriform, intraductal, and ductal adenocarcinoma) rather than percentage Gleason grade 4 is further supported as contra-indicator of deferred treatment for patients with GG2 prostate cancer.