Cribriform pattern (CP) and intraductal carcinoma of the prostate (IDC-P) are recognised as adverse histopathological markers. However, their precise prognostic weight in the post-radical prostatectomy (RP) setting remains poorly standardised. We performed a systematic review and meta-analysis to quantify the association between CP/IDC-P and biochemical recurrence (BCR).
A systematic search of MEDLINE, Scopus, and Web of Science was conducted for studies published from 2016 onwards, coinciding with the 2016 WHO and subsequent ISUP consensus recommendations. The primary endpoint was BCR. Hazard ratios (HR) were synthesised using random-effects models with restricted maximum likelihood (REML) estimation.
Eight retrospective studies were eligible for quantitative synthesis. The cumulative prevalence of CP/IDC-P was 27%. On univariable analysis, CP/IDC-P was significantly associated with BCR (HR: 2.76; 95% CI: 2.23-3.41). This association remained robust in multivariable models adjusting for pathological stage and Grade Group (HR: 2.59; 95% CI: 1.44-4.67) and CAPRA-based preoperative frameworks (HR: 1.78; 95% CI: 1.03-3.08). Isolated CP demonstrated a more stable prognostic signal (HR: 3.16) compared to IDC-P (HR: 4.24), the latter being characterised by wider prediction intervals. The main limitations include the retrospective nature of primary studies and the inherent risk of confounding.
CP and IDC-P are potent, independent predictors of BCR following RP. These findings support the mandatory reporting of such architectures according to ISUP standards and their integration into contemporary post-surgical risk-stratification algorithms to optimise follow-up and adjuvant therapy selection.
Prostate cancer and prostatic diseases. 2026 Aug 03 [Epub ahead of print]
Francesco Ditonno, Alessandro Veccia, Rui M Bernardino, Matteo Brunelli, Luca Cindolo, Giovanni Ferrari, Ugo Falagario, Jane K Nguyen, Riccardo Autorino, Riccardo Bertolo, Alessandro Antonelli
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. ., Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Diagnostics and Public Health, University of Verona, Verona, Italy., Centro Urologico Europeo (CUrE) Group, Modena, Italy., Department of Urology and Renal Transplantation, Azienda Ospedaliero-Universitaria Policlinico Riuniti, University of Foggia, Foggia, Italy., Department of Anatomic Pathology and Laboratory Medicine, Diagnostics Institute, Cleveland Clinic, Cleveland, OH, USA.