Molecular pathology of prostate cancer

Abstract

Prostate cancer (PC) is the most common noncutaneous malignancy in men in the United States and makes up almost 20% of all newly diagnosed cancer cases. 1 The initial presentation and clinical course of PC can vary greatly between patients. The clinical spectrum ranges from indolent disease with an exceedingly low risk of progression to highly aggressive disease variants with early recurrence and high rates of cancer-related death. 234 Given this disease heterogeneity, understanding factors that predict the future clinical behavior of PC in an individual patient has been of the highest interest in the field. For decades, the assessment of histopathologic features such as Gleason grade and grade group tumor grade, tumor volume, and tumor stage have been the most pertinent prognostic parameters on which clinical decision-making is based. This factor strongly emphasizes the important relevance of the pathologist in the care of PC patients. Over the past years, molecular diagnostic applications have been penetrating more and more into the daily practice of genitourinary pathology. Many of these novel molecular tools have the potential to improve diagnostic accuracy and predictive values and ultimately lead to better clinical outcomes. In the multidisciplinary care for patients with PC, pathologists will play an essential role in bridging molecular studies and clinical decision-making. In this review, we aim to provide a concise overview of relevant molecular alterations in PC and highlight opportunities for precision pathology in clinical practice, as well as delineate the challenges posed by the complex biology of PC.