# Cribriform growth pattern in prostate cancer

Source: https://onco.cc/terms/cribriform-prostate-cancer/  
OnCo record `cribriform-prostate-cancer` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A sieve-like growth pattern inside prostate cancer, named for the holes punched through a sheet of tumour cells. It is the worst-behaving form of Gleason pattern 4, and finding it on a biopsy is a reason to treat rather than to watch.

## Summary

The International Society of Urological Pathology defines the cribriform pattern as a confluent sheet of contiguous malignant epithelial cells with multiple glandular lumina easily visible at low power, with no intervening stroma or mucin separating the individual or fused glands. It is one of the morphologies inside Gleason pattern 4, and the ISUP 2014 consensus settled that any cribriform gland is assigned pattern 4 rather than pattern 3. Since then a run of studies has shown that it is the pattern that carries the risk: cribriform carcinoma in a prostatectomy specimen is associated with worse biochemical-recurrence-free, metastasis-free and disease-specific survival, and its presence in a pre-treatment biopsy predicts a higher pathological stage, upgrading at surgery and poorer outcomes after both surgery and radiotherapy. Most of that evidence is in Gleason score 7 tumours, grade groups 2 and 3, which is exactly where the decision between surveillance and treatment is made.

The Royal College of Pathologists made the presence of invasive cribriform carcinoma a core reporting item in the 2024 UK dataset, and both ISUP and the Genitourinary Pathology Society recommend excluding men whose biopsy shows it from active surveillance. Whether the size of the cribriform glands matters is unsettled: some series find no difference between large and small, one found large glands worse, and the definitions of large differ between studies, from more than twelve luminal spaces to twice the diameter of the neighbouring benign glands. The pattern is also hard to tell from intraductal carcinoma without an immunohistochemical stain for basal cells, and most of the outcome studies did not separate the two, so part of the risk attributed to cribriform growth may belong to intraductal carcinoma instead.

## Fields

- Kind: Term
- Last checked: 2026-09-25
- Also known as: cribriform; cribriform pattern; invasive cribriform carcinoma; large cribriform; small cribriform; cribriform prostate

## Sources

- Royal College of Pathologists G084: dataset for histopathology reports for prostatic carcinoma, version 4, October 2024: https://www.rcpath.org/static/8cc88604-2c8d-4df4-a99542df41c102af/G084-dataset-for-histopathology-reports-for-prostatic-carcinoma.pdf
- Kench et al., Histopathology 2022: WHO Classification of Tumours fifth edition, evolving issues in the classification, diagnosis and prognostication of prostate cancer: https://doi.org/10.1111/his.14711

## Connected records

- terms: [Active surveillance and observation](https://onco.cc/terms/active-surveillance-term/), [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/), [High-grade prostatic intraepithelial neoplasia (HGPIN)](https://onco.cc/terms/high-grade-pin/), [Intraductal carcinoma of the prostate (IDC-P)](https://onco.cc/terms/intraductal-carcinoma-prostate/), [Percentage of Gleason pattern 4](https://onco.cc/terms/percentage-gleason-pattern-4/), [Tumour differentiation (well / moderately / poorly differentiated)](https://onco.cc/terms/tumour-differentiation/), [Whole-mount pathology](https://onco.cc/terms/whole-mount-pathology/)
- cancers: [Ductal adenocarcinoma of the prostate](https://onco.cc/cancers/prostate-ductal-adenocarcinoma/), [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/)
- key papers: [Intraductal and ductal histology and lymphovascular invasion are associated with germline DNA-repair gene mutations in prostate cancer](https://onco.cc/key-papers/paper-isaacsson-velho-intraductal-germline-dna-repair-prostate-2018/)

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