A single-center study of prognostic impact and treatment implications of cribriform pattern in prostate cancer

INTRODUCTION: Cribriform prostate cancer (cPCa) is increasingly recognized for its aggressive behavior and poor prognosis compared to conventional acinar adenocarcinoma. It is associated with adverse pathological features and excludes patients from active surveillance, highlighting the need for accurate identification. This study aimed to evaluate oncologic outcomes and characterize subsequent treatment patterns in a single-center cohort of patients with cribriform prostate cancer. MATERIALS: We retrospectively analyzed 401 patients who underwent prostate biopsy and radical prostatectomy (RP) between 01/2020 and 12/2021 at a high-volume tertiary center. Of these, 112 patients had cPCa. Data on biopsy and prostatectomy specimens, post-treatment management, biochemical recurrence, and follow-up until August 2025 were collected. Cox regression was used to identify predictors of poor oncologic outcomes. RESULTS: Of the 112 patients with cPCa, 66.1% had high-risk disease, and 30.4% had intermediate-risk disease. Biopsy detected 40 cases, with an additional 72 identified in the final post-RP specimen. At diagnosis, 6.3% had metastatic disease. At the time of surgery, 19.2% had lymph node metastases, and 16.4% had positive surgical margins. The median follow-up was 54 months. Univariable analysis showed that high Gleason score (≥ 8), lymph node positivity, and locally advanced stage were associated with decreased systemic therapy-free survival. In metastatic disease, no differences were found in therapy duration or time to castration-resistant prostate cancer. CONCLUSION: cPCa is an aggressive subtype with poor prognosis, characterized by high-risk features and early need for systemic therapy. These findings underscore the need for prospective studies exploring multimodal treatments for this high-risk population.