The Current Status of the Pathology of Prostate Cancer

BACKGROUND: The pathology of prostate cancer in modern day medicine cannot be understood simply in terms of tissue patterns or genetic abnormalities. Efforts to accommodate changes in patient care delivery and reimbursement, combined with an explosion in information, have wrought major changes in pathology. METHODS: The author summarizes the current status of the pathology of prostate cancer in light of these influences. The detection of prostate cancer in needle biopsies, the diagnostic interpretations that tend to confuse clinicians, the prognostic factors in prostate cancer, and the effects of radiotherapy and hormone therapy on prostatic tissue are discussed. RESULTS: Collegial associations are difficult to maintain when consultants are spatially separated and patients are shuttled between primary care and specialty centers. Economic forces cannot be ignored, regardless of the level of altruism of individual practitioners. A medical environment governed by judgment and wisdom is difficult to maintain when external forces and even patients themselves demand application of the latest information to each case. CONCLUSIONS: Current trends in medicine offer almost as many pitfalls as promises. Information gathering and transfer tend to marginalize anatomic pathologists from patient care. Current pathology is affected by the influences of medicolegal and economic forces.