Could an Academic Review of Pathology Lead to Changes in Patient Care in Men With Prostate Cancer?

Abstract

PURPOSE/OBJECTIVE(S)\nApproximately 200,000 men per year are diagnosed with prostate cancer, a disease that causes over 30,000 deaths per year, making it the second leading cause of cancer mortality among men. There are multiple treatment options for patients with low, intermediate and high-risk disease. However, a successful treatment regimen is dependent on accurate pathologic evaluation of the Gleason Score (GS) in addition to imaging and physical exam findings. Here, we report our experience with changes in pathologic diagnosis seen in a multi-disciplinary community-based practice.\n\n\nMATERIALS/METHODS\nThis is a retrospective review of patients who had a pathologic diagnosis of prostate adenocarcinoma seen at our institution from Jan 2017 to March 2019. Patients underwent a re-review of their pathology at our institution with pathologists using established institutional protocols for pathologic review. All patients were seen in an academic multidisciplinary setting. Pathology was re-reviewed at our institution at or before the time of consult. Additionally, patient cases were discussed in a multi-disciplinary tumor board with Urology, Medical Oncology and Radiation Oncology. Medical records were reviewed and demographic data, initial and final pathologic diagnosis and any changes in treatment plans were recorded. Descriptive statistics were used in this analysis.\n\n\nRESULTS\nA total of 300 patients (pts) were treated in either the definitive or adjuvant/salvage setting for their prostate cancer. 23 pts had an initial GS 6 disease, 70 pts had GS 3+4 disease, 68 had GS 4+3 disease, 58 had GS 4+4, 72 had GS4+5 or 5+4 and 9 patients had Gleason 5+5 disease. 270 (90%) men underwent radiation therapy treatment for definitive prostate cancer and 30 (10%) men underwent radiation therapy in the adjuvant and/or salvage setting. 101 (34%) men had a change in pathologic diagnosis after re-review with our institution s pathologists, specifically 44 (44%) had a decrease or downgrade in Gleason score and 57 (56%) had an increase in Gleason score. 199 (66%) pts had no change in pathology on re-review. Additionally, 5 men had a change in pathology in the post op group versus 96 men had a change in pathology in the intact group (P\u202f=\u202f0.150). Interestingly, there were no changes in treatment plan in the post-op group versus 14 men had a change in treatment plan in the intact group. Similarly, there were 34 patients in the intact group who had changes in staging risk stratification after re-review and only 1 patient in the post-op group with changes in staging risk stratification.\n\n\nCONCLUSION\nOverall, we found that 34% patients had a change in pathologic diagnosis following re-review at a multi-disciplinary institution. These initial results suggest the importance of a multi-disciplinary, academic approach to not only the treatment but also diagnosis and staging for men with prostate cancer.