This study was designed to estimate the frequency with which changes in Gleason score because of a genitourinary pathologist's review changed prostate cancer treatment recommendations. The study cohort consisted of 602 patients who presented to a genitourinary oncologist for a second opinion after being diagnosed with prostate cancer based on a needle biopsy at a nonacademic institution from 1989 through 2001. Each of the prostate biopsy specimens was sent for review by a genitourinary pathologist. Applying the rule that low-risk patients would receive monotherapy, and intermediate or high-risk patients would receive combined modality therapy, the frequency with which treatment recommendations were changed by pathology review was calculated. Pathology review by a genitourinary pathologist changed the Gleason score by at least 1 point in 44% of cases. Upgrades were more common than downgrades and accounted for 81% [95% confidence interval: 76-86%] of the changes. Patients' risk category was increased in 10.8% of cases and was decreased in 3.4%. Risk category was changed from low risk to intermediate or high risk in 8.2%, but was changed from intermediate or high risk to low risk in only 0.9%. Genitourinary pathology review would have changed management in approximately 10% of men, mainly in the direction of combined therapy over monotherapy.
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