The impact of pathologic review by central pathologist on selection for treatment modality of localized prostate cancer in candidate for brachytherapy.

Abstract

213 Background: To evaluate the impact of pathological review by pathologist with genitourinary expertise (PGU) on treatment modality of localized prostate cancer, we analyzed migration of Gleason grade (GG), and final treatment decision in a cohort of patients who were candidate of permanent prostate brachytherapy (PPB). Methods: From February 2005 to July 2010, a total of 247 patients with localized prostate cancer diagnosed by local community hospital were referred to our hospital for PPB, and all pathological slides of the prostate biopsy were reviewed by single PGU. The patient finally selected their treatment modality based on our recommendation made by reference to the pathological review. Our indication of PPB, basically, is a patient classified good or intermediate risk by NCCN classification. In addition, a patient with primary GS 4 was regarded as unadapted case. Results: Six cases were reinterpreted as no cancer (2.4%), and GG change occurred in 95 cases (38.4%). GG was upgraded in 77 cases (31.2%), and downgraded in 18 cases (7.3%). As a result, a total of 86 patients changed their therapies, and 25 of 86 patients (29%) were changed their therapy based on the pathological review. Conclusions: Approximately 10% of patients were changed to proper therapies by PPB's pathological review. This study shows pathological review for biopsy specimen is mandatory for determination of treatment modality, especially in candidate for PPB. No significant financial relationships to disclose.

Assessment of Histological Remission in Ulcerative Colitis: Discrepancies Between Daily Practice and Expert Opinion

“…In cancer treatment where results from pathology examinations are crucial, central pathology reading of biopsies taken in the context of trials is ubiquitous 32 and has made its way into daily oncology care. [33][34][35] This concept appears to have traction in IBD trials, 36 but is not yet in daily practice. We applaud the development of novel UC histological activity indexes [37][38][39] because we need accurate assessment of histological activity in both IBD trials and clinical practice.…”