International Society of Urological Pathology consensus on cancer precursor lesions. Working Group 1: The prostate Journal Article


Authors: Iczkowski, K. A.; De Marzo, A. M.; Agarwal, N.; Berman, D. M.; Cimadamore, A.; Fine, S. W.; Greenland, N.; Khani, F.; Loda, M.; Lotan, T. L.; Varma, M.; Chinnaiyan, A.; Giannarini, G.; Huang, J.; Montironi, R.; Netto, G. J.; Osunkoya, A. O.; Ratliff, T.; Kristiansen, G.; Cheng, L.; van Leenders, G. J. L. H.; and Members of the ISUP GU Cancer Precursor Consensus Panel
Article Title: International Society of Urological Pathology consensus on cancer precursor lesions. Working Group 1: The prostate
Abstract: Working Group 1 at ISUP’s Cancer Precursors meeting (September 2024) evaluated 5 putative precursors of invasive prostate cancer: high-grade prostatic intraepithelial neoplasia (HGPIN), intraductal carcinoma (IDC), atypical intraductal proliferation (AIP), atypical adenomatous hyperplasia (AAH)/ adenosis, and proliferative inflammatory atrophy (PIA). Objectives were to compile recent evidence, interrogate current practices, and vote on recommendations, with 67% approval defined as consensus. Consensus was reached against the reporting of the low-grade form of PIN. HGPIN need not be reported when concomitant cancer or atypical small acinar proliferation suspicious for cancer exists adjacent to it, for biopsy or prostatectomy specimens. Finally, while the clinical significance of unifocal HGPIN in biopsies remains uncertain, there is stronger evidence for multifocal isolated HGPIN as a predictor of subsequent cancer detection. By consensus, multifocal HGPIN should continue being reported. Slight refinement was achieved regarding IDC criteria. The consensus opinion was that a dense cribriform to solid proliferation need not demonstrate marked nuclear atypia/ pleomorphism to qualify as IDC. The inverse scenario of marked atypia without dense cribriform/solid proliferation fell just short (65%) of consensus for IDC. Re-designating cribriform HGPIN as AIP achieved consensus. AIP found alone or with grade group 1 cancer warrants an explanatory comment. However, agreement was not attained to report AIP in the presence of invasive cancer, in either needle biopsy or prostatectomy. Finally, the optional reporting of PIA or AAH/adenosis in biopsies as pertinent negatives both fell short of consensus. This guidance should help pathologists standardize reporting, staying focused on the clinically actionable aspects of these lesions. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: prostate; prostatic intraepithelial neoplasia; intraductal carcinoma; consensus conference; precursor lesion; atypical intraductal proliferation
Journal Title: American Journal of Surgical Pathology
ISSN: 0147-5185
Publisher: Lippincott Williams & Wilkins  
Publication status: Online ahead of print
Date Published: 2025-06-23
Online Publication Date: 2025-06-23
Language: English
DOI: 10.1097/pas.0000000000002430
PROVIDER: scopus
PUBMED: 40545966
DOI/URL:
Notes: Article -- Source: Scopus
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  1. Samson W Fine
    466 Fine