Abstract
In prostate cancer, accurate diagnosis and grade group (GG) decision based on biopsy findings are essential for determining treatment strategies. Diagnosis by experienced urological pathologists is recommended; however, their contribution to patient benefits remains unknown. Therefore, we analyzed clinicopathological information to determine the significance of reassessment by experienced urological pathologists at a high-volume institution to identify factors involved in the agreement or disagreement of biopsy and surgical GGs. In total, 1325 prostate adenocarcinomas were analyzed, and the GG was changed in 452/1325 (34.1%) cases (359 cases were upgraded, and 93 cases were downgraded). We compared the highest GG based on biopsy specimens, with the final GG based on surgical specimens of 210 cases. The agreement rate between the surgical GG performed and assessed in our institute and the highest biopsy GG assessed by an outside pathologist was 34.8% (73/210); the agreement rate increased significantly to 50% (105/210) when biopsy specimens were reevaluated in our institute (chi-square test, P < 0.01). Multivariate logistic regression analysis showed that only the length of the lesion in the positive core with the highest GG in the biopsy was a significant factor for determining the agreement between biopsy GG and surgical GG, with an odds ratio of 1.136 (95% confidence interval: 1.057–1.221; P < 0.01). Thus, reassessment by experienced urological pathologists at high-volume institutions improved the agreement rate. However, it should be noted there is a high probability of discordance between a small number of lesions or short lesions and surgical GG.
Highlights
The incidence of prostate cancer is on the rise worldwide [1, 2]
The diagnosis was changed to an atypical gland because it was difficult to identify adenocarcinoma; two cases were changed to small cell carcinoma, two to sarcoma, and one to prostatic invasion of urothelial carcinoma
For the remaining 210 cases, we compared the highest grade group (GG) based on preoperative biopsy findings with the final GG based on surgical specimen findings
Summary
The incidence of prostate cancer is on the rise worldwide [1, 2]. There are various treatment options available, including hormonal therapy, radiation, carbon-ion radiotherapy, and1 3 Vol.:(0123456789)Virchows Archiv inexperienced pathologists [14,15,16], only a few cases are available to verify whether reassessments are truly beneficial for the patient [17]. The incidence of prostate cancer is on the rise worldwide [1, 2]. There are various treatment options available, including hormonal therapy, radiation, carbon-ion radiotherapy, and. Virchows Archiv inexperienced pathologists [14,15,16], only a few cases are available to verify whether reassessments are truly beneficial for the patient [17]. As our institution is a high-volume institution with experienced urological pathologists, we often reassess specimens from other institutes. We sought to determine the significance of reassessment at a high-volume institution and the factors involved in the agreement or disagreement between the GG based on the prostate needle core biopsy results and that based on surgical specimens
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