Prostate Biopsy Synoptic Report — CAP fields with AJCC staging & Grade Group criteria (ISUP)

Case / Specimen
Specimen details — cores
Include site mapping (e.g., R apex, L mid), targeted lesion IDs, and which cores are targeted.
Tumor summary
Grade Group (ISUP) — criteria
The International Society of Urological Pathology (ISUP) Grade Groups map Gleason scores into 5 prognostic groups. Use Gleason patterns recorded across cores and the highest combined score per case when assigning Grade Group.
Grade GroupGleason score (sum)Details / examples
Grade Group 1Gleason ≤6 (3+3)Low grade; patterns only 3 (no pattern 4 or 5)
Grade Group 2Gleason 3+4=7Predominant pattern 3 with some pattern 4
Grade Group 3Gleason 4+3=7Predominant pattern 4 with lesser pattern 3; worse prognosis than GG2
Grade Group 4Gleason 8 (4+4, 3+5, 5+3)High grade; includes 4+4 and combinations with pattern 5 present
Grade Group 5Gleason 9–10 (4+5, 5+4, 5+5)Highest grade; pattern 5 predominant or combined high-grade patterns
Notes: - When multiple cores show different Gleason scores, report the highest combined Gleason score and corresponding Grade Group for the case. - Document primary and secondary patterns (e.g., 4+3) and note any tertiary/small-volume pattern 5 if present — tertiary pattern 5 may influence prognosis though not always changing Grade Group. - Report presence of cribriform pattern and IDC‑P separately (associated with worse prognosis even within same Grade Group). - For percentage-based reporting (e.g., percent pattern 4), include when institutional practice requires for risk stratification.
Pathologic staging guidance — pT (detailed for biopsy/prostatectomy)
- pT1: Clinically inapparent tumor not palpable or visible by imaging. Subcategories: pT1a/b/c (pT1c = tumor identified by needle biopsy due to elevated PSA).

- pT2: Organ‑confined disease (one or both lobes). pT2a/pT2b/pT2c per extent definitions.

- pT3a: Extraprostatic extension (EPE) — microscopic or macroscopic beyond prostatic capsule.

- pT3b: Seminal vesicle invasion (SVI).

- pT4: Tumor fixed or invades adjacent structures other than seminal vesicles (bladder wall, rectum, pelvic wall).

- For biopsy reports: explicitly state biopsy limitations for staging. Comment if cores include periprostatic fat or seminal vesicle tissue (indicates likely pT3/pT3b if confirmed on prostatectomy).

- Record margin status and whether findings suggest need for imaging or multidisciplinary discussion.
Nodal & metastatic guidance (pN/pM)
- pN0 = no regional lymph node metastasis; pN1 = regional pelvic lymph node metastasis (obturator, internal/external iliac, presacral). Document number and stations. ENE should be recorded.
- pM0 = no distant metastasis; pM1 subcategories: M1a = nonregional lymph nodes, M1b = bone metastasis, M1c = other distant sites or multiple sites. For biopsy reports, include imaging/clinical data available and recommend confirmation if suspicion present.
AJCC Stage Group Tables & Detailed Criteria
Representative stage group mappings for prostate cancer (use AJCC manual for official tables and any prognostic stage adjustments).
Show/hide: Simplified Stage Group Table (prostate)
Biomarkers & Genomic Tests
Record method and specimen source. Genomic scores inform prognosis/management but are separate from AJCC staging.
Staging Entry & Rationale
Pathologist summary & Actions