Cribriform morphology area ratio and biochemical recurrence in Gleason score 4 + 4 prostate cancer patients following robot-assisted radical prostatectomy

Abstract Background Cribriform glands, regardless of their morphology and size, are categorized with Gleason pattern (GP) 4. However, recent studies indicate that the size and percentage of cribriform patterns in GP 4 are associated with risk of biochemical recurrence (BCR). Thus, we aimed to examine the prognostic value of the area and percentage of cribriform patterns in patients with Gleason score (GS) 4 + 4 prostate cancer who underwent robot-assisted radical prostatectomy (RARP). Methods We investigated 108 patients with GS 4 + 4 prostate cancer who underwent RARP. After digitally scanning the slides, we measured the area of the entire cancer and cribriform patterns. Predictive factors for BCR were explored using the log-rank test and Cox proportional hazard model analyses. Results Sixty-seven (62.0%) patients had a cribriform architecture in RARP specimens, and thirty-two (29.6%) experienced BCR. Median total cancer area (mm2), cribriform pattern area (mm2), and percentage of cribriform pattern area (% cribriform) were 427.70 (interquartile range [IQR], 171.65–688.53), 8.85 (IQR, 0–98.83), and 2.44 % (IQR, 0–33.70), respectively. In the univariate analyses, higher preoperative serum prostate-specific antigen levels, positive resection margin (RM), advanced pathological T stage, extraprostatic extension, larger total cancer area, larger cribriform morphology area, and higher % cribriform were significantly associated with BCR. Multivariate analysis demonstrated that PSA and % cribriform were independent predictors of BCR. Conclusions Higher % cribriform was associated with BCR in GS 4 + 4 prostate cancer following RARP.