title: Major shifts in the treatment and prognosis of prostate cancer due to changes in pathological diagnosis and grading.
abstract: OBJECTIVE
  To examine data on the changes in the accuracy of the diagnosis of prostate cancer and of Gleason grading in the modern era.
  
  
  METHODS
  The study comprised a pathological review within a multicentre study of patients with clinically localized prostate cancer diagnosed in the UK from 1991 to 1996 (inclusive) and treated by watchful-waiting or hormonal therapy alone. The clinical follow-up was available, histopathological appearances were reviewed and the Gleason score at diagnosis was compared with the Gleason score as analysed by a panel of genitourinary pathologists using internationally agreed criteria. In all, 1789 patients diagnosed with prostate cancer between 1991 and 1996 were reviewed, with disease-specific survival as the main outcome measure.
  
  
  RESULTS
  In all, 133 patients (7%) were reassigned a nonmalignant diagnosis. There was a significant reassignment in the Gleason score for those with cancer, with increases of Gleason score across a wide spectrum. In multivariate analysis the revised Gleason score was a more accurate predictor of prognosis than the original score.
  
  
  CONCLUSIONS
  Misdiagnosis and reassignment of Gleason score at diagnosis would have guided clinicians into large-scale changes in the management of patients. Current rates of misdiagnosis are unknown. If applicable nationally, these changes would have profound effects on the workload of prostate cancer management in the UK.
authors.affiliation: Department of Histopathology, St Bartholomew's Hospital, Queen Mary University of London, London, UK.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Berney
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Fisher
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: R Timothy D
authors.initials: RT
authors.lastname: Oliver
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
authors.forename: Paul
authors.initials: P
authors.lastname: Fearn
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.forename: Peter
authors.initials: P
authors.lastname: Scardino
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Foster
mesh_terms: D001707:Biopsy, Needle; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate
chemical_list: D017430:Prostate-Specific Antigen