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The highs and lows of grading intraductal carcinoma of the prostate
  1. JODIE AI LING MCDONALD1,2,
  2. Jonathan O’Brien1,3,
  3. Brian Kelly3,4,
  4. Declan Murphy3,5,
  5. Nathan Lawrentschuk1,3,5,6,
  6. Renu Eapen3,5,
  7. Catherine Mitchell7
  1. 1 Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
  2. 2 St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
  3. 3 Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. 4 Department of Urology, Eastern Health, Box Hill, Victoria, Australia
  5. 5 Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
  6. 6 Surgery, University of Melbourne and Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia
  7. 7 Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  1. Correspondence to Dr JODIE AI LING MCDONALD; JODIEMCDONALD42{at}GMAIL.COM

https://doi.org/10.1136/jcp-2024-209421

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    Accurate histological diagnosis and grading are essential for appropriate management of prostate cancer (PCa), yet there remain easily overlooked controversies in the pathological analysis. The Gleason score has been the cornerstone of PCa pathological analysis since Dr. Gleason’s work in the 1960s. The International Society of Urological Pathology (ISUP) and the Genitourinary Pathology Society (GUPS) have built on this understanding and released contemporary position papers.1 2 Each society endorsed the prognostic grade group (GG) system and achieved a consensus on many recommendations.3 Here, we focus on the specific discordance in the recommendation regarding grading intraductal carcinoma of the prostate (IDC-P) when present with invasive adenocarcinoma and use a case to highlight the clinical implications of these differences.

    IDC-P is characterised by a proliferation of atypical prostatic epithelial cells filling up and distending pre-existing prostatic ducts and acini, with at least a partially preserved basal cell layer.3 It is thought that IDC-P encompasses two different entities. In most cases, IDC-P is thought to represent extension of high-grade invasive adenocarcinoma into benign and pre-existing prostatic ducts, a process analogous to lymphovascular invasion (invasive IDC-P). However, it is hypothesised that isolated IDC-P (ie, not associated with invasive carcinoma) may occasionally represent a precursor lesion of prostate adenocarcinoma, although comprehensive sampling is required to exclude invasion.4

    There is an international consensus that isolated IDC-P (ie, without invasive carcinoma) should not be assigned a Gleason score,3 but there is no international consensus on how to incorporate IDC-P in the grading of samples with invasive prostate …

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    Footnotes

    • Handling editor Murali Varma.

    • Contributors - Contributorship Statement - All authors have made substantial contributions to the intellectual content of this article. JM – creation of manuscript. JO – creation and editing of manuscript. BK

      – editing of manuscript. DM – creative process and editing of manuscript. NL – editing and creative process of manuscript. RE – creative process, editing and surgical management. CM –

      creative process, overall direction of paper, editing of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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