Prognostic value of cribriform pattern and intraductal carcinoma of the prostate after radical prostatectomy: A systematic review and meta-analysis using contemporary consensus recommendations

Background Cribriform pattern (CP) and intraductal carcinoma of the prostate (IDC-P) are recognised as adverse histopathological markers. However, their precise prognostic weight in the post-radical prostatectomy (RP) setting remains poorly standardised. We performed a systematic review and meta-analysis to quantify the association between CP/IDC-P and biochemical recurrence (BCR).Methods A systematic search of MEDLINE, Scopus, and Web of Science was conducted for studies published from 2016 onwards, coinciding with the 2016 WHO and subsequent ISUP consensus recommendations. The primary endpoint was BCR. Hazard ratios (HR) were synthesised using random-effects models with restricted maximum likelihood (REML) estimation.Results Eight retrospective studies were eligible for quantitative synthesis. The cumulative prevalence of CP/IDC-P was 27%. On univariable analysis, CP/IDC-P was significantly associated with BCR (HR: 2.76; 95% CI: 2.23-3.41). This association remained robust in multivariable models adjusting for pathological stage and Grade Group (HR: 2.59; 95% CI: 1.44-4.67) and CAPRA-based preoperative frameworks (HR: 1.78; 95% CI: 1.03-3.08). Isolated CP demonstrated a more stable prognostic signal (HR: 3.16) compared to IDC-P (HR: 4.24), the latter being characterised by wider prediction intervals. The main limitations include the retrospective nature of primary studies and the inherent risk of confounding.Conclusions CP and IDC-P are potent, independent predictors of BCR following RP. These findings support the mandatory reporting of such architectures according to ISUP standards and their integration into contemporary post-surgical risk-stratification algorithms to optimise follow-up and adjuvant therapy selection.