Personalized prostate pathology reporting: Focus on communication and clinical utility

Histopathology parameters are generally critical for the management of prostate cancer. Current practice is focussed on accuracy, precision, reproducibility, standardization and completeness of this data collection. This review discusses issues with this reporting practice and suggests a simpler alternative approach focussed on the clinical utility of pathology data and effective communication of the histopathology 'message'. The principles of prostate cancer detection and management are significantly different from those of other cancers. These differences could have important implications for the histopathological diagnosis and reporting of prostate cancer. Management decisions are often based on pathology data from nontargeted prostate biopsies that are subject to significant sampling error, which precludes accurate determination of tumour size and grade. In contrast to other solid tumours, definitive tumour size, grade, and stage are available only in the minority of patients who have undergone complete tumour excision (radical prostatectomy). The availability of a serum marker (prostate-specific antigen) for monitoring patients after prostate biopsy or prostatectomy would also significantly impact the clinical utility of histopathological data in these specimens. While it is necessary to report all mandatory data items, pathologists should focus their resources on data that are of clinical significance in an individual case. A pragmatic approach to prostate biopsy reporting with less emphasis on precise determination of tumour extent and grade is recommended.