Dr. Zhou answers: What is 'cribriform cancer? And what does it means for active surveillance?
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Question: What is “cribriform cancer”? Up the Creek with Cribriform
Dr. Ming Zhou answers:
In pathology reports, you may see “cribriform cancer” or “cribriform cancer glands.”
“Cribriform” comes from Latin “cribrum”, or sieve. It is a term used by pathologists to describe prostate cancer glands with distinctive “spaces” or “holes” between cells, imparting a sieve-like appearance (see attached picture).
What does “cribriform cancer” mean?
Cribriform cancer in biopsy and prostatectomy specimens is considered an adverse pathological feature associated with other aggressive features of prostate cancer, including extraprostatic extension, seminal vesicle invasion, positive surgical margins, lymph node metastasis, distant metastasis, biochemical recurrence, and cancer-specific survival. This association is independent of other well-established pathological factors such as Grade Group and tumor volume measurement.
What should be done with “cribriform cancer”?
Cribriform cancer is graded as Gleason pattern 4 in the Grade Group. However, it is not otherwise incorporated in the commonly used risk tools such as NCCN (National Comprehensive Cancer Network) and CAPRA score (Carcinoma of Prostate Risk Assessment), although studies have shown the incorporation of the cribriform morphology in these risk stratification tools can improve their prognostication and help therapy decision-making.
Active surveillance is in general not suitable for patients when cribriform cancer is diagnosed in their prostate biopsies. NCCN guidelines also recommend germline testing for DNA damage response genes, such as BRCA2 when cribriform cancer is diagnosed in biopsy or prostatectomy.
Pathologists are recommended to report cribriform cancer when it is present in biopsy or prostatectomy specimens.
References:
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)
Prostate Cancer Early Detection Version 2.2023 — September 26, 2023
Ming Zhou, MD, is the Chair and Pathologist-in-Chief of the Tufts Medical Center, and Professor and Chair of the Department of Anatomic and Clinical Pathology, Tufts University School of Medicine in Boston. He has published over 200 peer-reviewed articles and numerous book chapters and edited five textbooks on urological and prostate pathology. He is currently a member of the United States and Canadian Academy of Pathology Board of Directors, and the immediate past President of the Genitourinary Pathology Society (GUPS), an international organization for urological pathologists.
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Breaking news: New column coming on genomics and Active Surveillance
TheActiveSurveillor.com is proud to announce that Udit Singhal, MD, will be writing a new column on active surveillance and genomics.
Singhal is one of the up-and-comers in this field: He’s a postdoctoral fellow in urologic oncology at the Mayo Clinic and soon will join the faculty at the University of Michigan. (Go Blue!) He has a young investigator grant to leverage artificial intelligence to optimize active surveillance and genetic testing with localized prostate cancer.
He says: “My goal is to improve the integration of genomics into randomized clinical trials in oncology and to rigorously assess the generalizability of randomized evidence at large.”
Dr. Singhal’s column is the sixth in TheActiveSurveillor.com line-up. The sixth batter in baseball usually is someone who makes good contact at the plate. But since I have an all-star team, I think Dr. S. holds his own as a power hitter.
Send your questions about AS and urology, radiology, pathology, sexual health, lifestyle, and now genomics via email to mailto:pros8canswers@gmail.com
Keep the questions short and sweet. They should be of general interest. Sign with your real name, or just initials, tell me where you live, how long you‘ve been on AS, how it going for you. Share a whimsical signature if you’re so inclined.