TiSBU Urologia Practice Questions - TiSBU - Título De Especialista Em Urologia (Sociedade Brasileira De Urologia AMB) Exam

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A 62-year-old man undergoes transperineal targeted prostate biopsy for a PI-RADS 4 lesion. Histopathology reveals adenocarcinoma with predominantly well-formed glands (Gleason pattern 3, 60%) alongside poorly formed/fused cribriform glands (Gleason pattern 4, 40%). According to the 2014/2019 International Society of Urological Pathology (ISUP) consensus, what is the corresponding ISUP Grade Group, and what is the clinical significance of the cribriform architectural pattern?

ISUP Grade Group 1; cribriform pattern indicates indolent behavior suitable for unmonitored observation. ISUP Grade Group 2; presence of cribriform pattern independently predicts adverse pathology, higher recurrence rates, and is considered an unfavorable feature for active surveillance. ISUP Grade Group 3; cribriform pattern mandates immediate systemic chemotherapy prior to any local therapy. ISUP Grade Group 4; cribriform pattern is classified as Gleason pattern 5 and confers a uniformly poor survival.

Correct Answer:

ISUP Grade Group 2; presence of cribriform pattern independently predicts adverse pathology, higher recurrence rates, and is considered an unfavorable feature for active surveillance.

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