title: The clinical impact of pathological review on selection the treatment modality for localized prostate cancer in candidates for brachytherapy monotherapy.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Pathological review of biopsy specimens is mandatory for the determination of treatment modality especially in candidates for monotherapy of permanent prostate brachytherapy.
authors.affiliation: Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kishimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Saika
authors.forename: Kensuke
authors.initials: K
authors.lastname: Bekku
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nose
authors.forename: Fernando
authors.initials: F
authors.lastname: Abarzua
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Motoo
authors.initials: M
authors.lastname: Araki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yanai
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D001706:Biopsy; D001918:Brachytherapy / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy*; D012189:Retrospective Studies