ISUP Histological Grading in Prostate Cancer Patients Undergoing Transrectal Prostate Biopsies

Abstract Introduction The prostate is the largest exocrine gland of the male reproductive system. The main prostatic conditions include prostatitis, benign prostatic hyperplasia, and prostate cancer. Prostate cancer is defined as the uncontrolled proliferation of prostatic epithelial cells and is the second most common cancer among men. The Gleason scoring system is used to assess prostate cancer by summing the two dominant histological patterns to classify its aggressiveness. In 2005, the ISUP modified this scale, introducing five prognostic groups. Objectives To determine the ISUP histological grade in patients undergoing transrectal biopsies. Materials and methods An observational, cross-sectional, analytical, and retrospective study was conducted. Histopathological reports from 361 patients treated between January 2014 and December 2024 at the “Dra. Isabel Ruiz Juárez” Pathology Clinic and Urocenter Veracruz were analyzed. Variables such as age, diagnosis, biopsy type, Gleason score, ISUP grade, and serum prostate-specific antigen (PSA) levels were evaluated. Statistical tests included chi-square, ANOVA, Spearman's rho, and odds ratio (OR), with significance set at p < 0.05. The study was approved by a research and ethics committee. Results All patients were male, with a mean age of 69 years (SD ± 8.75). The most frequent ISUP grades were: ISUP 1 (37.2%), ISUP 4 (19.1%), ISUP 2 and 3 (17% each), and ISUP 5 (9.6%). Patients were grouped by age into ≤55 years, 56-69 years, and ≥70 years, with the latter being the most affected group (49.6%). PSA analysis showed the highest levels in ISUP 4 (364.41 ng/mL), followed by ISUP 5 (231.83 ng/mL). Conclusions Most patients were diagnosed at early stages of prostate cancer. Advanced age is a relevant risk factor; thus, physicians are encouraged to promote prostate screening starting at age 40 through digital rectal examination and serum PSA testing. Key messages • It is recommended to hold talks in hospitals and clinics to encourage men aged 50 and older to undergo prostate screenings. • The use of the ISUP grade is recommended as a prognostic and preventive method for prostate cancer.