Pitfalls in the diagnosis of prostatic cancer: retrospective review of 1791 cases with clinical outcome

Abstract

Aims: To assess the possible reasons for error in the diagnosis of prostatic cancer with available follow‐up data. Method and results: A cohort of 1791 cases of prostatic cancer diagnosed in the UK between 1990 and 1996 was examined. All cases were clinically localized at presentation, treated by non‐curative methods and detailed follow‐up was available. A panel of genitourinary pathologists reviewed the pathology of all cases. One hundred and thirty‐three (7.5%) of cases were reassigned to a non‐malignant diagnosis. Where possible, reasons for the initial diagnosis were given. These included severe atrophy, inflammatory induced atypia, sclerosing adenosis, atypical adenomatous hyperplasia and basal cell hyperplasia. Follow‐up of these patients showed an extremely low death rate from prostatic cancer: lower than that for the Gleason combined score of five or less tumours diagnosed in this series. Conclusions: Many morphological entities potentially mimic prostatic cancer and may be responsible for misdiagnosis in routine specimens. Continuing education in prostatic morphology and immunohistochemistry may have helped reduce this error rate.