Should active surveillance in prostate cancer patients be based on a single histological assessment?

摘要

Introduction Active surveillance (AS) is always associated with a degree of uncertainty, whetheror not prostate biopsy (TRUSBx) results indeed can be relied on for evaluation of cancer stageand histological grade, as the most commonly observed limitations of TRUSBx are undergrading,understaging and underestimating true prostate cancer (PCa) volume. We evaluated prostate cancercharacteristics in men who could have been offered active surveillance based on clinical featuresand TRUSBx results, and compared them with the same patient’s histology results following theirradical prostatectomy (RP). Moreover, we assessed the level of consistency in reporting TRUSBxand RP specimens by the same pathologist on two separate occasions, as well as by anotherindependent pathologist.Material and methods All patients who underwent RP between 2005 and 2008 had their medical recordsreviewed retrospectively. All histological specimens were prospectively re–evaluated by the samepathologist, as well as by a second to assess for intra– and interobserver variability, respectively.Results Eight out of a total of 124 patients who underwent RP could have been offered AS on the basisof initial microscopic reports. However, there was significant intra– and interobserver variability. Thedifferences in the histological grade of the specimens obtained from TRUSBx and RP, reported by thesame pathologist and by the second pathologist were apparent in 6 and 4 cases, and in 7 and 6 patients,respectively.Conclusions We recommend that the decision about AS should be made after at least two pathologistshave jointly reviewed and agreed on the TRUSBx histology results