Old school, new insight: Revisiting histomorphology in the modern era of prostate cancer risk stratification

Histologic evaluation has long been a cornerstone of prostate cancer diagnosis and management. While the Gleason grading system has significantly improved prognostic stratification, the full potential of histomorphology remains underrecognized-particularly in an era increasingly shaped by molecular diagnostics. This review explores the evolution of prostate cancer grading, emphasizing recent advances in histologic subclassification and the prognostic significance of specific architectural patterns. Features such as cribriform growth and intraductal carcinoma have emerged as critical markers of aggressive disease, emphasizing the diagnostic and prognostic value embedded in detailed morphologic assessment. As precision oncology continues to evolve, integrating refined histologic features into routine pathology reporting offers a practical, cost-effective, and universally accessible strategy to improve risk stratification. Recent evidence suggests that nuanced histologic interpretation can complement-and in some cases rival-the prognostic utility of genomic and AI-based platforms. Incorporating these refinements into diagnostic workflows enhances prognostic precision, supports personalized treatment planning, and facilitates clearer communication across multidisciplinary teams. Reaffirming the prognostic relevance of histomorphology in the modern era not only strengthens diagnostic accuracy but also reinforces the enduring role of pathology in the landscape of precision oncology.