Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan.
World J Urol. 2012 Jun;30(3):375-8. doi: 10.1007/s00345-011-0738-4. Epub 2011 Aug 17.
To evaluate the impact of pathological review by pathologist with genitourinary expertise (PGU) on treatment modality of localized prostate cancer, we analyzed Gleason grade (GG) migration and the final treatment decision in a cohort of patients designated for permanent prostate brachytherapy (PPB).
From February 2005 to July 2010, a total of 247 patients with localized prostate cancer diagnosed by local community hospitals were referred to our hospital for PPB monotheray. All pathologic slides of prostate biopsies were reviewed by a single PGU. Patients ultimately selected their treatment modality from our recommendations based on the review. Indication for PPB monotherapy was the NCCN classification of patients as good or intermediate risk. In addition, patient with Primary GG 4 was regarded as unadapted case.
Six cases were reinterpreted as no cancer (2.4%). GG change occurred in 94 cases (38.1%) of which 77 (81.9%) were upgraded and 17 (18.1%) downgraded. Of the total 247 patients, 86 (34.8%) changed therapies and 30 (12.1%) did so based on the pathologic slide review.
Pathological review of biopsy specimens is mandatory for the determination of treatment modality especially in candidates for monotherapy of permanent prostate brachytherapy.
通过具有泌尿生殖系统专业知识的病理学家（PGU）进行病理复查，评估其对局限性前列腺癌治疗方式的影响，我们分析了一组经选择行永久性前列腺近距离放射治疗（PPB）的患者中 Gleason 分级（GG）的迁移和最终治疗决策。
从 2005 年 2 月至 2010 年 7 月，共有 247 例由当地社区医院诊断为局限性前列腺癌的患者被转介至我院行 PPB 单药治疗。所有前列腺活检的病理切片均由一位 PGU 进行单独复查。根据复查结果，患者最终从我们的建议中选择自己的治疗方式。PPB 单药治疗的适应证为 NCCN 分类为低危或中危的患者。此外，原发 GG 为 4 级的患者被视为不适应病例。
有 6 例被重新诊断为无癌症（2.4%）。94 例（38.1%）的 GG 发生改变，其中 77 例（81.9%）升级，17 例（18.1%）降级。在 247 例患者中，86 例（34.8%）改变了治疗方案，其中 30 例（12.1%）基于病理切片复查改变了治疗方案。
对活检标本进行病理复查对于确定治疗方式是必要的，尤其是在选择永久性前列腺近距离放射治疗单药治疗的患者中。
