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    The 2019 Genitourinary Pathology Society (GUPS) white paper on contemporary grading of prostate cancer
    (College of American Pathologists, 2021) Epstein, Jonathan I.; Amin, Mahul B.; Fine, Samson W.; Algaba, Ferran; Aron, Manju; Beltran, Antonio Lopez; Brimo, Fadi; Cheville; John C.; Colecchia, Maurizio; Comperat, Eva; Cunha, Isabela Werneck da; Delprado, Warick; DeMarzo, Angelo M.; Giannico, Giovanna A.; Gordetsky, Jennifer B.; Guo, Charles C.; Hansel, Donna E.; Hirsch, Michelle S.; Humphrey, Jiaoti HuangPeter A.; Jimenez, Rafael E.; Khani, Francesca; Kong, Qingnuan; N. Kryvenko, Oleksandr; Kunju, L. Priya; Lal, Priti; Latour, Mathieu; Lotan, Tamara; Maclean, Fiona; Magi-Galluzzi, Cristina; Mehra, Rohit; Menon, Santosh; Miyamoto, Hiroshi; Montironi, Rodolfo; J. Netto, George; Nguyen, Jane K.; O. Osunkoya, Adeboye; Parwani, Anil; Robinson, Brian D.; Rubin, Mark A.; Shah, Rajal B.; So, Jeffrey S.; Takahashi, Hiroyuki; Tavora, Fabio; Tretiakova, Maria S.; True, Lawrence; Wobker, Sara E.; Yang, Ximing J.; Zhou, Ming; Zynger, Debra L.; Trpkov, Kiril; Baydar, Dilek Ertoy; Faculty Member; School of Medicine; 8025
    Context.—Controversies and uncertainty persist in prostate cancer grading. Objective.—To update grading recommendations. Data Sources.—Critical review of the literature along with pathology and clinician surveys. Conclusions.—Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 þ 4 ¼ 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace ‘‘tertiary grade pattern’’ in radical prostatectomy (RP) with ‘‘minor tertiary pattern 5 (TP5),’’ and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 þ 5 ¼ 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (.50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) ‘‘atypical intraductal proliferation (AIP)’’ is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice. © 2021 College of American Pathologists. All rights reserved.