+
Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Atypical intraductal proliferation in prostate biopsy — a diagnostic grey zone with clinical implications

Nature Reviews Urology (2025)Cite this article

Subjects

Abstract

Atypical intraductal proliferation (AIP) is considered a borderline lesion, characterized by architectural complexity and cytological atypia greater than that seen in high-grade prostatic intraepithelial neoplasia, but insufficient to fulfil the diagnostic criteria for intraductal carcinoma (IDC). Consequently, AIP remains diagnostically challenging, and the clinical significance of this lesion is still uncertain. Emerging evidence suggests that AIP in prostate biopsy specimens is a strong predictor of unsampled IDC and other adverse pathological features, warranting reconsideration of the AIP role in prostate cancer risk stratification. Results from prospective and molecular studies indicate that AIP frequently coexists with intermediate-risk prostate cancer and shares molecular alterations with IDC, such as PTEN loss and ERG overexpression, reinforcing AIP potential as a marker of occult aggressive disease. Considering the growing emphasis on precision diagnostics and active surveillance in prostate cancer management, understanding the implications of AIP is particularly relevant.

Key points

  • Atypical intraductal proliferation (AIP) on biopsy lies morphologically between high-grade prostatic intraepithelial neoplasia and intraductal carcinoma (IDC), and frequently coexists with clinically significant cancer, serving as a practical warning sign of occult aggressive disease.

  • Across contemporary cohorts, AIP on biopsy is strongly enriched in patients with adverse pathology at prostatectomy (IDC and/or cribriform, ≥GG3, extraprostatic extension)

  • AIP often shares ERG and/or PTEN status with adjacent invasive carcinoma, reinforcing a biological continuum with IDC; immunohistochemistry should support, rather than replace, morphological assessment in clinical decision-making.

  • MRI helps to triage repeat biopsy after multifocal high-grade prostatic intraepithelial neoplasia or AIP but cannot distinguish histological subtypes reliably; imaging changes (Prostate Imaging-Reporting and Data System upgrade, or target growth) should be interpreted alongside histology and clinical risk.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Histological features of IDC of the prostate.
Fig. 2: Histological features of HGPIN.
Fig. 3: Histological features of AIP.

References

  1. McNeal, J. E. & Yemoto, C. E. M. Spread of adenocarcinoma within prostatic ducts and acini: morphologic and clinical correlations. Am. J. Surg. Pathol. 20, 802–814 (1996).

    Article  CAS  PubMed  Google Scholar 

  2. Tsuzuki, T. Intraductal carcinoma of the prostate: a comprehensive and updated review. Int. J. Urol. 22, 140–145 (2015).

    Article  PubMed  Google Scholar 

  3. Van Der Kwast, T. H. et al. ISUP consensus definition of cribriform pattern prostate cancer. Am. J. Surg. Pathol. 45, 1118–1126 (2021).

    Article  PubMed  Google Scholar 

  4. Iczkowski, K. A. et al. Cribriform prostate cancer: morphologic criteria enabling a diagnosis, based on survey of experts. Ann. Diagn. Pathol. 52, 151733 (2021).

    Article  PubMed  Google Scholar 

  5. Cohen, R. J., Wheeler, T. M., Bonkhoff, H. & Rubin, M. A. A proposal on the identification, histologic reporting, and implications of intraductal prostatic carcinoma. Arch. Pathol. Lab. Med. 131, 1103–1109 (2007).

    Article  PubMed  Google Scholar 

  6. Haffner, M. C. et al. Molecular evidence that invasive adenocarcinoma can mimic prostatic intraepithelial neoplasia (PIN) and intraductal carcinoma through retrograde glandular colonization. J. Pathol. 238, 31–41 (2016).

    Article  CAS  PubMed  Google Scholar 

  7. Moses, K. A. et al. NCCN Guidelines® insights: prostate cancer early detection, version 1.2023: featured updates to the NCCN guidelines. J. Natl Compr. Canc. Netw. 21, 236–246 (2023).

    Article  PubMed  Google Scholar 

  8. Epstein, J. I. & Herawi, M. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J. Urol. 175, 820–834 (2006).

    Article  PubMed  Google Scholar 

  9. Shah, R. B., Yoon, J., Liu, G. & Tian, W. Atypical intraductal proliferation and intraductal carcinoma of the prostate on core needle biopsy: a comparative clinicopathological and molecular study with a proposal to expand the morphological spectrum of intraductal carcinoma. Histopathology 71, 693–702 (2017).

    Article  PubMed  Google Scholar 

  10. Joniau, S., Goeman, L., Pennings, J. & Van Poppel, H. Prostatic intraepithelial neoplasia (PIN): importance and clinical management. Eur. Urol. 48, 379–385 (2005).

    Article  CAS  PubMed  Google Scholar 

  11. Manning, T. G. et al. Atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia in the era of multiparametric magnetic resonance imaging: a contemporary review. Urology 107, 5–10 (2017).

    Article  PubMed  Google Scholar 

  12. Aldaoud, N. et al. Interobserver variability in the diagnosis of high-grade prostatic intraepithelial neoplasia in a tertiary hospital in Northern Jordan. Clin. Pathol. https://doi.org/10.1177/2632010X19898472 (2020).

  13. Shah, R. B., Li, J., Dhanani, N. & Mendrinos, S. ERG overexpression and multifocality predict prostate cancer in subsequent biopsy for patients with high-grade prostatic intraepithelial neoplasia. Urol. Oncol. 34, 120.e1–120.e7 (2016).

    Article  CAS  PubMed  Google Scholar 

  14. Iczkowski, K. A. et al. International Society of Urological Pathology consensus on cancer precursor lesions. Working Group 1: the prostate. Am. J. Surg. Pathol. https://doi.org/10.1097/PAS.0000000000002430 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Guo, C. C. & Epstein, J. I. Intraductal carcinoma of the prostate on needle biopsy: histologic features and clinical significance. Mod. Pathol. 19, 1528–1535 (2006).

    Article  PubMed  Google Scholar 

  16. Miyai, K. et al. Clinicopathological analysis of intraductal proliferative lesions of prostate: intraductal carcinoma of prostate, high-grade prostatic intraepithelial neoplasia, and atypical cribriform lesion. Hum. Pathol. 45, 1572–1581 (2014).

    Article  PubMed  Google Scholar 

  17. Shah, R. B. & Zhou, M. Atypical cribriform lesions of the prostate: clinical significance, differential diagnosis and current concept of intraductal carcinoma of the prostate. Adv. Anat. Pathol. 19, 270–278 (2012).

    Article  PubMed  Google Scholar 

  18. Shah, R. B., Magi-Galluzzi, C., Han, B. & Zhou, M. Atypical cribriform lesions of the prostate: relationship to prostatic carcinoma and implication for diagnosis in prostate biopsies. Am. J. Surg. Pathol. 34, 470–477 (2010).

    Article  PubMed  Google Scholar 

  19. Bernardino, R. et al. Intraductal prostate cancer affinity for lymphatic-predominant metastases through 18F-DCFPyL‒prostate-specific membrane antigen‒positron emission tomography/CT scans in pretreatment prostate cancer patients. J. Urol. 211, 586–593 (2024).

    Article  PubMed  Google Scholar 

  20. Bernardino, R. et al. Lymphotropic pattern of prostate-specific membrane antigen-detected metastases among biochemically recurrent radical prostatectomy patients with cribriform disease. Eur. Urol. Focus 9, 1016–1023 (2023).

    Article  PubMed  Google Scholar 

  21. Dinerman, B. F., Bernstein, A. N., Khani, F. & Hu, J. C. Intraductal carcinoma of the prostate: a risk for rapid recurrence. Urology 105, e1–e2 (2017).

    Article  PubMed  Google Scholar 

  22. Montironi, R. et al. Prostate cancer with cribriform morphology: diagnosis, aggressiveness, molecular pathology and possible relationships with intraductal carcinoma. Expert. Rev. Anticancer Ther. 18, 685–693 (2018).

    Article  CAS  PubMed  Google Scholar 

  23. Kweldam, C. F. et al. Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer. Mod. Pathol. 28, 457–464 (2015).

    Article  PubMed  Google Scholar 

  24. Böttcher, R. et al. Cribriform and intraductal prostate cancer are associated with increased genomic instability and distinct genomic alterations. BMC Cancer 18, 8 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Van Der Kwast, T. et al. Biopsy diagnosis of intraductal carcinoma is prognostic in intermediate and high risk prostate cancer patients treated by radiotherapy. Eur. J. Cancer 48, 1318–1325 (2012).

    Article  PubMed  Google Scholar 

  26. Bonkhoff, H. et al. Intraductal carcinoma of the prostate: precursor or aggressive phenotype of prostate cancer? Prostate 73, 442–448 (2013).

    Article  CAS  PubMed  Google Scholar 

  27. Iczkowski, K. A. et al. Digital quantification of five high-grade prostate cancer patterns, including the cribriform pattern, and their association with adverse outcome. Am. J. Clin. Pathol. 136, 98–107 (2011).

    Article  PubMed  Google Scholar 

  28. Han, B. et al. ETS gene aberrations in atypical cribriform lesions of the prostate: implications for the distinction between intraductal carcinoma of the prostate and cribriform high-grade prostatic intraepithelial neoplasia. Am. J. Surg. Pathol. 34, 478–485 (2010).

    Article  PubMed  Google Scholar 

  29. Hickman, R. A. et al. Atypical intraductal cribriform proliferations of the prostate exhibit similar molecular and clinicopathologic characteristics as intraductal carcinoma of the prostate. Am. J. Surg. Pathol. 41, 550–556 (2017).

    Article  PubMed  Google Scholar 

  30. Bhattarai, R. et al. Atypical intraductal proliferation in prostate needle core biopsy: validation as a marker of unsampled adverse pathology in a clinicopathologic series of 142 new patients. Am. J. Surg. Pathol. 49, 515–522 (2025).

    Article  PubMed  Google Scholar 

  31. Shah, R. B. et al. Atypical intraductal proliferation detected in prostate needle biopsy is a marker of unsampled intraductal carcinoma and other adverse pathological features: a prospective clinicopathological study of 62 cases with emphasis on pathological outcomes. Histopathology 75, 346–353 (2019).

    Article  PubMed  Google Scholar 

  32. Epstein, J. I. et al. The 2019 Genitourinary Pathology Society (GUPS) white paper on contemporary grading of prostate cancer. Arch. Pathol. Lab. Med. 145, 461–493 (2021).

    Article  PubMed  Google Scholar 

  33. Humphrey, P. A., Moch, H., Cubilla, A. L., Ulbright, T. M. & Reuter, V. E. The 2016 WHO classification of tumours of the urinary system and male genital organs — Part B: prostate and bladder tumours. Eur. Urol. 70, 106–119 (2016).

    Article  PubMed  Google Scholar 

  34. Bernardino, R. M. et al. Limitations of prostate biopsy in detection of cribriform and intraductal prostate cancer. Eur. Urol. Focus 10, 146–153 (2023).

    Article  PubMed  Google Scholar 

  35. Bernardino, R. M. et al. Undetected cribriform and intraductal prostate cancer at biopsy is associated with adverse outcomes. Prostate Cancer Prostatic Dis. 28, 187–192 (2024).

    Article  PubMed  Google Scholar 

  36. Cai, Q. et al. Sensitivity of multiparametric MRI and targeted biopsy for detection of adverse pathologies (cribriform Gleason pattern 4 and intraductal carcinoma): correlation of detected and missed prostate cancer foci with whole mount histopathology. Urol. Oncol. 40, 452.e1–452.e8 (2022).

    Article  PubMed  Google Scholar 

  37. Varma, M. Intraductal carcinoma of the prostate: a guide for the practicing pathologist. Adv. Anat. Pathol. 28, 276–287 (2021).

    Article  CAS  PubMed  Google Scholar 

  38. Iczkowski, K. A. et al. Intraductal carcinoma of the prostate: interobserver reproducibility survey of 39 urologic pathologists. Ann. Diagn. Pathol. 18, 333–342 (2014).

    Article  PubMed  Google Scholar 

  39. Varma, M., Egevad, L., Delahunt, B. & Kristiansen, G. Reporting intraductal carcinoma of the prostate: a plea for greater standardization. Histopathology 70, 504–507 (2017).

    Article  PubMed  Google Scholar 

  40. Varma, M. et al. Intraductal carcinoma of prostate reporting practice: a survey of expert European uropathologists. J. Clin. Pathol. 69, 852–857 (2016).

    Article  PubMed  Google Scholar 

  41. Sessine, M. S. et al. Can MRI help inform which men with a history of multifocal high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation remain at an elevated risk for clinically significant prostate cancer? J. Urol. 211, 234–240 (2024).

    Article  PubMed  Google Scholar 

  42. Srirangam, V. et al. Atypical small acinar proliferation and high grade prostatic intraepithelial neoplasia: should we be concerned? an observational cohort study with a minimum follow-up of 3 years. Curr. Urol. 10, 199–205 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Carletti, F. et al. Diagnostic accuracy of multiparametric MRI for detecting unconventional prostate cancer histology: a systematic review and meta-analysis. Eur. Radiol. https://doi.org/10.1007/s00330-025-11603-3 (2025).

    Article  PubMed  Google Scholar 

  44. Taylor, B. S. et al. Cancer cell article integrative genomic profiling of human prostate cancer. Cancer Cell 18, 11–22 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Robinson, D. et al. Integrative clinical genomics of advanced prostate cancer. Cell 161, 1215–1228 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Chaux, A. et al. Loss of PTEN expression is associated with increased risk of recurrence after prostatectomy for clinically localized prostate cancer. Mod. Pathol. 25, 1543–1549 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Yoshimoto, M. et al. FISH analysis of 107 prostate cancers shows that PTEN genomic deletion is associated with poor clinical outcome. Br. J. Cancer 97, 678–685 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Carver, B. S. et al. Reciprocal feedback regulation of PI3K and androgen receptor signaling in PTEN-deficient prostate cancer. Cancer Cell 19, 575–586 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Lee, E. et al. PTEN loss is associated with adverse outcomes in the setting of salvage radiation therapy. Eur. Urol. Oncol. 7, 1513–1519 (2024).

    Article  PubMed  Google Scholar 

  50. Hamid, A. A. et al. Compound genomic alterations of TP53, PTEN, and RB1 tumor suppressors in localized and metastatic prostate cancer. Eur. Urol. 76, 89–97 (2019).

    Article  CAS  PubMed  Google Scholar 

  51. Rubin, M. A., Maher, C. A. & Chinnaiyan, A. M. Common gene rearrangements in prostate cancer. J. Clin. Oncol. 29, 3659 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Schneider, T. M. & Osunkoya, A. O. ERG expression in intraductal carcinoma of the prostate: comparison with adjacent invasive prostatic adenocarcinoma. Mod. Pathol. 27, 1174–1178 (2014).

    Article  CAS  PubMed  Google Scholar 

  53. Martini, C. et al. Distinct patterns of biomarker expression for atypical intraductal proliferations in prostate cancer. Virchows Arch. Int. J. Pathol. 485, 723–728 (2024).

    Article  CAS  Google Scholar 

  54. Sorvina, A. et al. Appl1, sortilin and syndecan-1 immunohistochemistry on intraductal carcinoma of the prostate provides evidence of retrograde spread. Pathology 55, 792–799 (2023).

    Article  CAS  PubMed  Google Scholar 

  55. Vormittag-Nocito, E. et al. In-depth comparison of genetic variants demonstrates a close relationship between invasive and intraductal components of prostate cancer. Mod. Pathol. 36, 100130 (2023).

    Article  CAS  PubMed  Google Scholar 

  56. Khani, F. et al. Intraductal carcinoma of the prostate in the absence of high-grade invasive carcinoma represents a molecularly distinct type of in situ carcinoma enriched with oncogenic driver mutations. J. Pathol. 249, 79–89 (2019).

    Article  CAS  PubMed  Google Scholar 

  57. Rijstenberg, L. L. et al. Identification of intraductal-to-invasive spatial transitions in prostate cancer: proposal for a new unifying model on intraductal carcinogenesis. Histopathology 86, 1091–1100 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ito, T. et al. PTEN loss in intraductal carcinoma of the prostate has low incidence in Japanese patients. Pathol. Int. 73, 542–548 (2023).

    Article  CAS  PubMed  Google Scholar 

  59. Taylor, R. A. et al. Germline BRCA2 mutations drive prostate cancers with distinct evolutionary trajectories. Nat. Commun. 8, 13671 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Lotan, T. L. et al. Cytoplasmic PTEN protein loss distinguishes intraductal carcinoma of the prostate from high-grade prostatic intraepithelial neoplasia. Mod. Pathol. 26, 587–603 (2013).

    Article  CAS  PubMed  Google Scholar 

  61. Bettendorf, O. et al. Chromosomal imbalances, loss of heterozygosity, and immunohistochemical expression of TP53, RB1, and PTEN in intraductal cancer, intraepithelial neoplasia, and invasive adenocarcinoma of the prostate. Genes Chromosomes Cancer 47, 565–572 (2008).

    Article  CAS  PubMed  Google Scholar 

  62. McNeal, J. E., Villers, A., Redwine, E. A., Freiha, F. S. & Stamey, T. A. Microcarcinoma in the prostate: its association with duct-acinar dysplasia. Hum. Pathol. 22, 644–652 (1991).

    Article  CAS  PubMed  Google Scholar 

  63. Oliai, B. R., Kahane, H. & Epstein, J. I. Can basal cells be seen in adenocarcinoma of the prostate? An immunohistochemical study using high molecular weight cytokeratin (clone 34βE12) antibody. Am. J. Surg. Pathol. 26, 1151–1160 (2002).

    Article  PubMed  Google Scholar 

  64. Varma, M., Alchami, F. S. & Griffiths, D. F. R. Retained basal cells in metastatic prostate cancer. Histopathology 69, 338–340 (2016).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Princess Margaret Cancer Centre, Division of Urology University of Toronto, Toronto, Ontario, Canada

    Rui M. Bernardino, Neil Fleshner & Rui Bernardino

  2. Nova Medical School, Nova University of Lisbon, Lisbon, Portugal

    Rui M. Bernardino

  3. Department of Pathology and Cancer Biology and Epigenetics Group, Research Center of IPO Porto CI-IPOP, Portuguese Oncology Institute of Porto IPO Porto/Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal

    João Lobo

  4. ICBAS — School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal

    João Lobo

  5. Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Jihad Kaouk

  6. Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

    Theodorus van der Kwast & Susan Prendeville

  7. Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy

    Fabio Zanotti

  8. Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy

    Lorenzo Bianchi

  9. Department of Urology, University of Cincinnati, Cincinnati, OH, USA

    Alberto Martini

  10. Department of Urology, Medical University of Silesia, Zabrze, Poland

    Pawel Rajwa

  11. Department of Urology, Comprehensive Cancer Center, Medical, University of Vienna, Vienna, Austria

    Pawel Rajwa

  12. Division of Surgery and Interventional Science, University College London, London, UK

    Veeru Kasivisvanathan

  13. Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy

    Giancarlo Marra

  14. Division of Urology, Department of Surgical Sciences, Molinette Hospital, Citta della salute e della scienza and University of Turin, Turin, Italy

    Giancarlo Marra

  15. Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Lorenzo Bianchi

  16. Division of Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy

    Matteo Bauckneht

  17. Division of Hygiene and International Science, University College London, London, UK

    Francesco Giganti

  18. Vita Salute San Raffaele Hospital, Milan, Italy

    Francesco Giganti

  19. Innsbruk Medical University, Innsbruck, Austria

    Isabel Heidegger

  20. University College London, London, UK

    Veeru Kasivisvanathan

  21. University Hospital Essen, Essen, Germany

    Claudia Kesch

  22. Department of Urology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy

    Rossella Nicoletti

  23. CHU de Lille, Lille, France

    Jonathan Olivier

  24. Department of Urology, Universität Hamburg-Eppendorf, Hamburg, Germany

    Felix Preisser

  25. Centre of Postgraduate Medical Education, Warsaw, Poland

    Pawel Rajwa

  26. Urology Department, Institut Mutualiste Montsouris, Paris, France

    Lara Rodriguez-Sanchez

  27. Department of Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands

    Timo Soeterik

  28. Department of Surgery, Oncology and Urology, Urology Clinic, University of Padua, Padua, Italy

    Fabio Zattoni

  29. Division of Urology, IRCCS Ospedale San Martino, Genova, Italy

    Francesca Ambrosini

  30. University of Foggia, Foggia, Italy

    Ugo Falagario

  31. Department of Surgical Sciences, Humanitas University, Milano, Italy

    Vittorio Fasulo

  32. Department of Urology, Semmelweis University, Budapest, Hungary

    Tamás Fazekas

  33. Leuven Cancer Institute, Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Alexander Giesen

  34. Erasmus MC, Rotterdam, Netherlands

    Renee Hogehout

  35. Department of Urology, CHRU Tours, Tours, France

    Jennifer Le Guevelou

  36. La Sapienza University, Rome, Italy

    Martina Maggi

  37. Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy

    Chiara Mercinelli

  38. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Marcin Miszczyk

  39. Hospital Universitario Virgen de las Nieves, Granada, Spain

    Ignacio Puche Sanz

  40. University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Marie Christine Roesch

  41. Department of Urology, Department of Urology, St. Antonius Hospital, Utrecht, Netherlands

    Matthijs Scheltema

  42. University Medical Center Freiburg, Freiburg, Germany

    August Sigle

  43. Department of Urology, Rigshospitalet, Copenaghe, Denmark

    Hein Stroomberg

  44. The Jikei University School of Medicine, Tokyo, Japan

    Akihiro Matsukawa

Authors
  1. Rui M. Bernardino
    View author publications

    Search author on:PubMed Google Scholar

  2. João Lobo
    View author publications

    Search author on:PubMed Google Scholar

  3. Jihad Kaouk
    View author publications

    Search author on:PubMed Google Scholar

  4. Theodorus van der Kwast
    View author publications

    Search author on:PubMed Google Scholar

  5. Susan Prendeville
    View author publications

    Search author on:PubMed Google Scholar

  6. Fabio Zanotti
    View author publications

    Search author on:PubMed Google Scholar

  7. Lorenzo Bianchi
    View author publications

    Search author on:PubMed Google Scholar

  8. Alberto Martini
    View author publications

    Search author on:PubMed Google Scholar

  9. Pawel Rajwa
    View author publications

    Search author on:PubMed Google Scholar

  10. Veeru Kasivisvanathan
    View author publications

    Search author on:PubMed Google Scholar

  11. Giancarlo Marra
    View author publications

    Search author on:PubMed Google Scholar

  12. Neil Fleshner
    View author publications

    Search author on:PubMed Google Scholar

Consortia

Young Academic Urologists Working Group Prostate Cancer Board

  • Giancarlo Marra
  • , Lorenzo Bianchi
  • , Matteo Bauckneht
  • , Francesco Giganti
  • , Isabel Heidegger
  • , Veeru Kasivisvanathan
  • , Claudia Kesch
  • , Alberto Martini
  • , Rossella Nicoletti
  • , Jonathan Olivier
  • , Felix Preisser
  • , Pawel Rajwa
  • , Lara Rodriguez-Sanchez
  • , Timo Soeterik
  • , Fabio Zattoni
  • , Francesca Ambrosini
  • , Ugo Falagario
  • , Vittorio Fasulo
  • , Tamás Fazekas
  • , Alexander Giesen
  • , Renee Hogehout
  • , Jennifer Le Guevelou
  • , Martina Maggi
  • , Chiara Mercinelli
  • , Marcin Miszczyk
  • , Ignacio Puche Sanz
  • , Marie Christine Roesch
  • , Matthijs Scheltema
  • , August Sigle
  • , Hein Stroomberg
  • , Akihiro Matsukawa
  •  & Rui Bernardino

Contributions

All authors researched data for the article. R.M.B., J.L., J.K., T.V.D.K., S.P., L.B., A.M., P.R., V.K. and G.M. contributed substantially to discussion of the content. R.M.B., J.L., J.K., T.V.D.K., S.P., F.Z. and N.F. wrote the article. All authors reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Rui M. Bernardino.

Ethics declarations

Competing interests

The authors declare no competing interests.

Peer review

Peer review information

Nature Reviews Urology thanks Toyonori Tsuzuki, Rodolfo Montironi and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bernardino, R.M., Lobo, J., Kaouk, J. et al. Atypical intraductal proliferation in prostate biopsy — a diagnostic grey zone with clinical implications. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01106-7

Download citation

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41585-025-01106-7

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing
点击 这是indexloc提供的php浏览器服务，不要输入任何密码和下载