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IS SECOND OPINION PATHOLOGIC CONFIRMATION NECESSARY FOR PATIENTS WITH PROSTATE CANCER?
Beth A. Drzewiecki, M.D., Brook Harnisch, MD, Aaron Weinberg, B.S., Richard K. Babayan, M.D., David S. Wang, M.D..
Boston Medical Center, Boston, MA, USA.

BACKGROUND: Many patients are referred to tertiary care centers after diagnosis of prostate cancer. Most hospitals mandate internal review of pathology specimens prior to surgical treatment. The purpose of this study was to determine if internal review of outside prostate biopsy slides led to a change in diagnosis or Gleason score. In addition, the cost was assessed.
METHODS: Outside pathology slides from 55 patients referred to our institution for surgical treatment of prostate cancer were reviewed. Gleason score from outside pathology reports was correlated to Gleason score on internal review by urologic pathologists in our institution’s department of Pathology.
RESULTS: Of the 55 patients, 53 (96.4%) had no change in diagnosis or Gleason score. Two patients with a microscopic focus of Gleason 3+3 prostate cancer had a change in diagnosis to atypical microacinar proliferation highly suspicious for prostate cancer on internal review. An additional 8 patients with a microscopic focus of Gleason 3 +3 prostate cancer had no change of diagnosis on internal review. The cost of each pathologic consultation was $133 with a total cost of $7,315.
CONCLUSIONS: In this series we demonstrate a 96.4% concurrence rate of Gleason score on prostate biopsy specimens on patients referred to our hospital. The high cost of internal pathologic review with little difference in results questions whether or not the practice continues to be universally warranted for prostate cancer. Patients with microscopic foci of Gleason 3+3 prostate cancer on biopsy should continue to undergo internal review prior to definitive treatment.


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