- Email: [email protected]
C103 Influence of re-evaluation of histopathological material on therapy in patients with prostate cancer
C103
Influence of re-evaluation of histopathological material on therapy in patients with prostate cancer Eur Urol Suppl 2013;12;e1211
Nyk L.1, Dobruch J.1, Dzik T.2, Wysocki M.3, Gołąbek T.4, Chłosta P.5, Borówka A.6 1Postgraduate
Medical Center., Dept. of Urology. European Health Ceter Otwock, Otwock, Poland, 2Interforest Hospital, Dept. of
Pathology, Warszawa, Poland, 3Bielański Hospital, Dept. of Pathology, Warszawa, Poland, 4Jagiellonian University, Dept. of Urology., Kraków, Poland, 5Jagiellonian University, Dept. of Urology, Kraków, Poland, 6Postgraduate Medical Center, Dept. of Urology. European Health Ceter Otwock, Otwock, Poland INTRODUCTION & OBJECTIVES: Prostate cancer is the second most prevalent and fatal malignancy in men living in Poland. Pathology examination of prostate needle biopsy determines further management. Radical prostatectomy without lymphadenectomy is recommended in men with low-risk disease, whereas prostatectomy with extended pelvic lymph node dissection should be performed in intermediate- or high-risk cases. The former has shorter operation time and considerably lower risk of complications in contrast to the latter. To identify patients who would have received different treatment if their prostate biopsy results changed following microscopic reexamination. MATERIAL & METHODS: The men, who underwent prostatectomy between 2001 and 2008, had their biopsy results reassessed by the same pathologist who reported on them initially, as well as by the second, independent pathologist. There were two major categories of tumor grading used for comparison: category 1 low grade PCa (GI.s. 2-6); category 2 intermediate and high grade PCa (GI.s. 7-10). The objective was to identify the cases where differences between pathology results would have ultimately altered the choice of surgical treatment. RESULTS: The revised biopsy results, performed by the same pathologist, were different as compared to the initial assessment: primary vs. revised results in category 2 were 28.2% and 48.5%, whereas primary vs. revised results in category 1 were 71.8% and 51.5%, respectively. In 25.2% of cases, who had less extensive procedure initially, a prostatectomy with pelvic lymph node dissection would have been needed should the revised core biopsy results were to be relied on. Similarly in 4.8% of prostate cancer patients, an extensive lymphadenectomy would have been avoided. Comparison of GI grading results between two pathologists, showed 66.9% concordance in reporting. The second pathologist’s assessments were less favourable compared to the first: category 2 was identified in 54.4% vs. 48.5% of men and category 1 in 45.6% vs. 51.5%, respectively. In this comparison, similary to the first, 19,4% of cases, who had less extensive procedure initially, a prostatectomy with pelvic lymph node dissection would have been needed should the revised core biopsy results were to be relied on. In 13,6% % of prostate cancer patients, an extensive lymphadenectomy would have been avoided. CONCLUSIONS: In our study re- evaluation of prostate biopsy specimen would have changed treatment option in large number of patients. We think that re-evaluation of histopathological material should be the standard of care in prostate cancer patient during qualification to operation.
Influence of re-evaluation of histopathological material on therapy in patients with prostate cancer Eur Urol Suppl 2013;12;e1211
Nyk L.1, Dobruch J.1, Dzik T.2, Wysocki M.3, Gołąbek T.4, Chłosta P.5, Borówka A.6 1Postgraduate
Medical Center., Dept. of Urology. European Health Ceter Otwock, Otwock, Poland, 2Interforest Hospital, Dept. of
Pathology, Warszawa, Poland, 3Bielański Hospital, Dept. of Pathology, Warszawa, Poland, 4Jagiellonian University, Dept. of Urology., Kraków, Poland, 5Jagiellonian University, Dept. of Urology, Kraków, Poland, 6Postgraduate Medical Center, Dept. of Urology. European Health Ceter Otwock, Otwock, Poland INTRODUCTION & OBJECTIVES: Prostate cancer is the second most prevalent and fatal malignancy in men living in Poland. Pathology examination of prostate needle biopsy determines further management. Radical prostatectomy without lymphadenectomy is recommended in men with low-risk disease, whereas prostatectomy with extended pelvic lymph node dissection should be performed in intermediate- or high-risk cases. The former has shorter operation time and considerably lower risk of complications in contrast to the latter. To identify patients who would have received different treatment if their prostate biopsy results changed following microscopic reexamination. MATERIAL & METHODS: The men, who underwent prostatectomy between 2001 and 2008, had their biopsy results reassessed by the same pathologist who reported on them initially, as well as by the second, independent pathologist. There were two major categories of tumor grading used for comparison: category 1 low grade PCa (GI.s. 2-6); category 2 intermediate and high grade PCa (GI.s. 7-10). The objective was to identify the cases where differences between pathology results would have ultimately altered the choice of surgical treatment. RESULTS: The revised biopsy results, performed by the same pathologist, were different as compared to the initial assessment: primary vs. revised results in category 2 were 28.2% and 48.5%, whereas primary vs. revised results in category 1 were 71.8% and 51.5%, respectively. In 25.2% of cases, who had less extensive procedure initially, a prostatectomy with pelvic lymph node dissection would have been needed should the revised core biopsy results were to be relied on. Similarly in 4.8% of prostate cancer patients, an extensive lymphadenectomy would have been avoided. Comparison of GI grading results between two pathologists, showed 66.9% concordance in reporting. The second pathologist’s assessments were less favourable compared to the first: category 2 was identified in 54.4% vs. 48.5% of men and category 1 in 45.6% vs. 51.5%, respectively. In this comparison, similary to the first, 19,4% of cases, who had less extensive procedure initially, a prostatectomy with pelvic lymph node dissection would have been needed should the revised core biopsy results were to be relied on. In 13,6% % of prostate cancer patients, an extensive lymphadenectomy would have been avoided. CONCLUSIONS: In our study re- evaluation of prostate biopsy specimen would have changed treatment option in large number of patients. We think that re-evaluation of histopathological material should be the standard of care in prostate cancer patient during qualification to operation.