Open Access

ARTICLE

Prostate cancer pathology audits: is central pathology review still warranted?

Neil D’Souza¹, D. Andrew Loblaw¹, Alexandre Mamedov², Linda Sugar³, Lori Holden¹

1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
2 Department of Clinical Trial and Epidemiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
3 Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Address correspondence to Neil D’Souza, Odette Cancer Centre, TG-216, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto ON M4N 3M5 Canada

Canadian Journal of Urology 2012, 19(3), 6256-6260.

Abstract

Introduction: Estimating the risk of extraprostatic extension and the probability of recurrence with different treatment modalities is common practice in cancer management. A strong predictor of recurrence and organ-confined disease is tumor grade. However, differences exist between genitourinary and non-specialist pathologists in grading prostate cancer. As such, the primary objective of this study was to assess the accuracy of non-specialist prostate cancer biopsies at our institution by analyzing the proportion of cases changing pathologic risk category upon expert review.
Materials and methods: Log books from 2003, where our genitourinary pathologists reviewed prostate needle-core biopsies, were used to identify cases. A retrospective chart review was completed, and descriptive statistics were used to summarize the results for the following synoptic variables: Gleason score (10 and 20), number of biopsy sites, overall % involvement, perineural invasion – PNI (present/absent), extracapsular extension – ECE (present/absent).
Results: A total of 151 patients were reviewed. Twenty-eight percent of cases (42/151) had a change in risk category after expert review. Of the 98 low-risk cases, 33% were upgraded in risk category. Of the 24 intermediate-risk cases, 12% were upgraded to high risk and none were downgraded. Of the 29 high-risk cases, 24% were downgraded in risk category.
Conclusion: All referred patients should continue to have their pathology centrally reviewed. This practice will help facilitate optimal prostate cancer management and improve quality of care. While these findings are dated given changes in pathologic practice, such changes do not necessarily equate with disparity elimination or reduction; conclusions can only be drawn with a more recent audit to determine whether such disparities still exist.

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