Related Experiment Video
Updated: Jun 16, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Digital pathology for repeat prostate biopsy reassessment during active surveillance: an institutional experience
Ludovica Pepe1, Mara Curduman2, Pietro Pepe3
1Anatomic Pathology Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina; PhD Program in Translational Molecular Medicine and Surgery, Department of Biomedical Sciences, Dental Sciences and Morpho-functional Imaging, University of Messina.
Introduction:
Repeat biopsy remains central to active surveillance (AS) because upgrading and tumor burden may change management.
Methods:
This retrospective paired workflow study included 38 men and 47 repeat biopsy sessions (2023-2025), comprising 846 biopsy cores and 871 H&E slides. Whole-slide imaging (WSI) and conventional microscopy were compared after a washout interval. QuPath was used only for pathologist-guided tumorlength and greatest percentage of cancer (GPC) documentation.
Results:
On the first eligible repeat biopsy, upgrading to ISUP Grade Group (GG) 2 occurred in 7/38 men (18.4%; 95% CI, 7.7- 34.3). No GG3, cribriform morphology, or intraductal carcinoma was identified. Protocol-linked reclassification occurred in 11/38 men (28.9%). Slide-level cancer-detection agreement was 856/871 (98.3%; kappa = 0.91), and raw patient-level agreement for upgrading was 36/38 (94.7%; kappa = 0.80). After adjudication, no upgraded patient remained missed. QuPathsupported measurement was interpretable in 79/101 positive core-level assessments (78.2%), with excellent agreement (ICC = 0.98) and shorter median measurement time (41 s vs 78 s).
Conclusions:
WSI reproduced management-relevant conventional microscopy outputs in repeat AS biopsies. Its value was organizational and documentary, not autonomous cancer detection or grading.
