Cribriform Growth in Gleason Score 7 Prostatic Adenocarcinoma and Its Association with Pathological Parameters.

OBJECTIVE: To quantify the proportion of cribriform pattern in Gleason score (GS) 7 prostate cancer (PCa) and evaluate its association with established pathological parameters. STUDY DESIGN: An analytical study. Place and Duration of the Study: Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan, from January 2023 to July 2025. METHODOLOGY: The study included 44 cases of prostatic adenocarcinoma (Grade Groups 2 and 3 [GG2 and GG3]). All histological slides were independently reviewed by two expert histopathologists. The percentage of Gleason pattern 4 (GP4) in GG2 and GG3 tumours and the presence of cribriform architecture were recorded. Cribriform pattern was categorised as absent, <20%, or ≥20%. Associations with GG, intraductal carcinoma, tertiary pattern 5, perineural invasion (PNI), lymphovascular invasion, and tumour volume were analysed using Fisher's exact test. RESULTS: The mean age of patients was 68.4 ± 10.8 years. Cribriform architecture was identified in 23 (52.2%) cases, with ≥20% cribriform pattern in 8 (18.2%) cases. A significant association was observed between a cribriform pattern ≥20% and PNI (p = 0.047), higher GG (GG3) (p = 0.032), and an increasing GP4 burden in both GG2 and GG3 tumours (p = 0.041 and p = 0.038, respectively). No significant associations were found with other parameters. Subgroup analyses within individual GGs did not show statistically significant associations. CONCLUSION: Cribriform GP4 is frequent in GS 7 PCa. It correlates with adverse pathological features. Routine reporting of cribriform architecture may refine risk stratification and provide more personalised management of patients with intermediate-risk PCa. KEY WORDS: Cribriform pattern, Gleason score, Histopathology, Prostate cancer.