A new review of the 2014 International Society of Urological Pathology (ISUP) guidance and subsequent studies have led researchers to develop a series of updated recommendations on prostate cancer staging.
Among other issues, the recommendations address percentage pattern 4 in Gleason score 7 tumours; percentage patterns 4 and 5 or 4/5 in Gleason score 8-10 disease; and minor (≤5%) high-grade patterns when either 2 or 3 patterns are present.
It is recognised that, for many of the issues, a strong evidence base does not exist and further research studies are required. The proposed recommendations mostly reflect consolidated expert opinion, and many are classified as provisional. For some items, there are reporting options that reflect local requirements and models.
The authors hope that future research and consensus activities will address some of the deficiencies, for instance, in the handling of tertiary patterns in radical prostatectomy cases. “However, for the time being, the proposed recommendation framework is pragmatic and will help ensure some uniformity of approach moving forward. The proposed recommendations also allow some flexibility in reporting which reflects the variation in urological pathology practice internationally,” they say.
The recommendations are published in the journal Pathology.