Should active surveillance in prostate cancer patients be based on a single histological assessment?

Active surveillance (AS) is always associated with a degree of uncertainty, whether or not prostate biopsy (TRUSBx) results indeed can be relied on for evaluation of cancer stage and histological grade, as the most commonly observed limitations of TRUSBx are undergrading, understaging and underestimating true prostate cancer (PCa) volume. We evaluated prostate cancer characteristics in men who could have been offered active surveillance based on clinical features and TRUSBx results, and compared them with the same patient's histology results following their radical prostatectomy (RP). Moreover, we assessed the level of consistency in reporting TRUSBx and RP specimens by the same pathologist on two separate occasions, as well as by another independent pathologist.

All patients who underwent RP between 2005 and 2008 had their medical records reviewed retrospectively. All histological specimens were prospectively re-evaluated by the same pathologist, as well as by a second to assess for intra- and interobserver variability, respectively.

Eight out of a total of 124 patients who underwent RP could have been offered AS on the basis of initial microscopic reports. However, there was significant intra- and interobserver variability. The differences in the histological grade of the specimens obtained from TRUSBx and RP, reported by the same pathologist and by the second pathologist were apparent in 6 and 4 cases, and in 7 and 6 patients, respectively.

We recommend that the decision about AS should be made after at least two pathologists have jointly reviewed and agreed on the TRUSBx histology results.