The impact of pathology review on treatment recommendations for patients with adenocarcinoma of the prostate
Abstract
This study was designed to estimate the frequency with which changes in Gleason score because of a genitourinary pathologist's review changed prostate cancer treatment recommendations. The study cohort consisted of 602 patients who presented to a genitourinary oncologist for a second opinion after being diagnosed with prostate cancer based on a needle biopsy at a nonacademic institution from 1989 through 2001. Each of the prostate biopsy specimens was sent for review by a genitourinary pathologist. Applying the rule that low-risk patients would receive monotherapy, and intermediate or high-risk patients would receive combined modality therapy, the frequency with which treatment recommendations were changed by pathology review was calculated. Pathology review by a genitourinary pathologist changed the Gleason score by at least 1 point in 44% of cases. Upgrades were more common than downgrades and accounted for 81% [95% confidence interval: 76-86%] of the changes. Patients' risk category was increased in 10.8% of cases and was decreased in 3.4%. Risk category was changed from low risk to intermediate or high risk in 8.2%, but was changed from intermediate or high risk to low risk in only 0.9%. Genitourinary pathology review would have changed management in approximately 10% of men, mainly in the direction of combined therapy over monotherapy.
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It is estimated that the error rate of cancer histopathology can be as high as 23%.
“This is important, as it is estimated that the error rate of cancer histopathology can be as high as 23% (20–23).”
From Radiomics: Images Are More than Pictures, They Are Data (2016) · cites this paper as [21]
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- Authors
- Nguyen, P. L., Schultz, D., Renshaw, A. A., Vollmer, R. T., Welch, W. R., Cote, K., & D’Amico, A. V.
- Affiliations
- Brigham and Women's Hospital (US)
- Millersville University (US)
- Baptist Hospital of Miami (US)
- Duke Medical Center (US)
- Venue
- Urologic Oncology: Seminars and Original Investigations
- Publisher
- Elsevier BV
- Published
- 2004-07
- Volume
- 22
- Issue
- 4
- Pages
- 295-299
- ISSN
- 1078-1439 (ISSN-L)
- OpenAlex
- W2007494001
- Cited by
- 57
- References
- 14
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 7 · 2014: 2 · 2013: 1 · 2012: 4
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Urologic Oncology Seminars and Original Investigations (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Doris Duke Charitable Foundation
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Health Sciences › Medicine › Oncology › Cancer Diagnosis and Treatment
- Keywords
- prostate adenocarcinoma, Gleason score, pathology review, second opinion, prostate biopsy, risk stratification, treatment guidelines, multimodal therapy, monotherapy, Gleason score upgrade
- MeSH terms
- Adenocarcinoma, Aged, Combined Modality Therapy, Humans, Male, Middle Aged, Neoplasm Staging, Patient Care Planning, Prostatic Neoplasms, Retrospective Studies, Reproducibility of Results, Cohort Studies, Observer Variation, Risk Assessment
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