Platinum PriorityReferring to the article published on pp. 458–468; 459–482 of this issueTumors of the Urinary System and Male Genital Organs: 2022 World Health Organization Classification and Multidisciplinarity
Introduction
This issue of European Urology contains two extensive reviews based on the 5th edition of the World Health Organization (WHO) Classification of Tumours of the Urinary System and Male Genital Organs, hereafter called the “Blue Book” [1]:
- •
Part A: renal, penile, and testicular tumors, by Dr. Holger Moch et al [2], and
- •
Part B: prostate and urinary tract tumors, by Dr. George J. Netto et al [3].
The two reviews summarize the most relevant changes for renal, penile, testicular, prostate, and urinary tract tumors. The clinical, radiological, molecular, histologic, and immunohistochemical criteria, as well as molecular biomarkers, are described [2]. The aim is to keep different specialties—uropathologists, urologists, oncologists, radiotherapists, and basic and translational researchers—informed on contemporary and relevant developments in the “terminology, epidemiology, pathogenesis, histopathology, diagnostic molecular pathology, and prognostic and predictive progress in genitourinary tumors” [3].
An editorial on the 4th edition of the Blue Book and two related papers in European Urology were published in 2016 by my co-workers, including the senior author (R.M.) of this contribution [4]. Shortcomings of the 4th edition were discussed in that editorial, with a comparison to the 3rd edition published in 2004 and based on data available up to 2002. According to the papers by Moch et al [2] and Netto et al [3] and the 2022 book [1], these weaknesses have been resolved, so the 5th edition will be useful to and appreciated by uropthalogists and clinicians from the professional point of view. Some topics that we consider important in this role of the 5th edition of the Blue Book and emphasized in the two papers are briefly dealt with in subsequent sections here (Appendix A).
Section snippets
Concept of molecularly defined renal tumor entities
The review by Moch et al [2] contains an interesting section on the current approach to classification of renal cell tumors, in comparison with hematopathology or central nervous system tumor (CNS) classifications, where “the current WHO classification also combined histologic patterns with molecular diagnostics to form an integrated diagnosis” [2]. For decades, a genotype-phenotype correlation was put forward by conventional cytogenetic and comparative genomic hybridization analyses for renal
Diagnostic, prognostic, and predictive molecular markers
The 5th edition of the Blue Book [1], as also indicated by Moch et al [2] and Netto et al [3], provides comprehensive reports on the latest findings for molecular markers for each tumor from diagnostic, prognosis, and prediction perspectives. In particular, the new section on Essential and desirable diagnostic criteria briefly summarizes “morphologic diagnostic criteria, combined with immunohistochemistry and relevant molecular tests” [1]. Molecular markers were already included in the previous
Digital pathology and artificial intelligence
The 5th edition of the Blue Book includes a collection of digital slides of tumors of the urinary system and male genital organs, including the prostate and urinary tract [1], [2], [3]. This is a great departure from the previous two editions and underscores the future role of digital pathology (DP), a key issue further explored at the time of the COVID-19 pandemic that has opened new ways of working for pathology, including smart working from home [10]. DP allows a change from classical
PCa grading, patient information, and patient advocacy
The Gleason system has been modified over the years, most recently after the International Society of Urological Pathology (ISUP) 2019 consensus conference and the 2019 white paper by the Genitourinary Pathology Society (GUPS) [11], [12]. There are some differences between the recommendations from the two societies that cannot be resolved on the basis of the currently available evidence [1], [3], [11], [12]. “In the interim, while awaiting more definitive evidence to resolve the differences
Conclusions
The knowledge of readers of European Urology has been enriched by Moch et al [2] and Netto et al [3] with their vital updates on neoplasms of the urinary system and male genital organs and their clinical significance. All this will lead to further improvements in the prevention, diagnosis, and management of genitourinary cancers in individual cases via adoption of a multidisciplinary approach in which urologists, oncologists, radiotherapists, radiologists, pathologists, and basic and
References (15)
- et al.
The 2022 World Health Organization classification of tumours of the urinary system and male genital organs—part A: renal, penile, and testicular tumours
Eur Urol
(2022) - et al.
The 2022 World Health Organization classification of tumors of the urinary system and male genital organs—part B: prostate and urinary tract tumors
Eur Urol
(2022) - et al.
Pathology and genetics: tumours of the urinary system and male genital system: clinical implications of the 4th edition of the WHO classification and beyond
Eur Urol
(2016) - et al.
Integrated proteogenomic characterization of clear cell renal cell carcinoma
Cell
(2019) - et al.
Prostate cancer. Multidisciplinary approach: a key to success
Crit Rev Oncol Hematol
(2008) - International Agency for Research on Cancer. WHO classification of tumours: urinary and male genital tumours. ed. 5....
- et al.
Tumours of the kidney
International Agency for Research on Cancer. Tumours of the urinary system and male genital organs
(2004)
Cited by (5)
Long noncoding RNA GPRC5D-AS1 in renal cell carcinoma: a molecular mechanism study
2024, Translational Andrology and UrologyThe mechanism and clinical application of DNA damage repair inhibitors combined with immune checkpoint inhibitors in the treatment of urologic cancer
2023, Frontiers in Cell and Developmental BiologyUpdate on combined immunotherapy for the treatment of advanced renal cell carcinoma
2023, Human Vaccines and ImmunotherapeuticsThe diagnosis of benign renal tumors on limited material
2022, Cancer Cytopathology