Samenvatting De huidige diagnostiek en behandeling van prostaatkankerzorg is complex. Zeker complexe interventies, zoals robotprostatectomie, vragen om concentratie, teneinde een goed meetbaar optimaal kwaliteitsniveau te kunnen behalen. Volume is noodzakelijk om kortcyclische kwaliteitsverbeteringen te kunnen implementeren en evalueren. Tevens is volume nodig om een doorlopend inzicht te geven aan alle betrokken medische en verpleegkundige zorgprofessionals en om een optimale logistieke en kwaliteitsstructuur te kunnen neerzetten. In regionale Comprehensive Prostate Cancer Networks (CPCNs) is zorg geconcentreerd waar nodig en dichtbij huis indien mogelijk. Daarbij is er een nadrukkelijke rol voor elk ziekenhuislid, in samenwerking met de eerste lijn. Het uitgangspunt van een CPCN is om op alle locaties binnen dit netwerk hetzelfde niveau van zorg te leveren, middels uniformering van informatie, diagnostiek, zorgpaden, deelname aan kwaliteitsindicatoren, waaronder de Patient Reported Outcome Measures (PROMs), continue monitoring, kwaliteitsverbetering en wetenschap. Samenwerking volgens de zorglijnen biedt niet alleen voordelen voor de patiënt, maar zeker ook voor de participerende instanties. Een dergelijke samenwerking is immers kostenefficiënt en zal overdiagnostiek en -behandeling reduceren. Verbetering van uitkomsten en van processen, én kostenbeheersing, worden gerealiseerd
Background
The minimum volume standard is 100 robot-assisted radical prostatectomy (RARP) procedures per hospital in the Netherlands, so patients have to be referred to high-volume surgical centers for RARP. During preoperative work-up, prostate biopsies taken elsewhere are reassessed, with upgrading or downgrading of the initial Gleason grade group a possible consequence.
Objective
To determine if prostate biopsy reassessment leads to adjustment of the surgical plan regarding a nerve-sparing approach and extended pelvic lymph node dissection (ePLND) during RARP.
Design, setting, and participants
For 125 men who were referred to the Prosper prostate center at Canisius Wilhelmina Hospital (CWH) in the Netherlands between 2013 and 2016, results for the initial assessment of prostate biopsy by a local uropathologist were compared to results for biopsy reassessment by dedicated uropathologists at CWH.
Results and limitations
The pathologists reached agreement in 80% of the cases. In cases for which there was disagreement (
n
= 25), biopsy revision involved upgrading of the initial grade group in 68% and downgrading in 32%. Biopsy reassessment led to a change in surgical plan in ten cases (8%). As a result of upgrading, ePLND was performed in three patients (2%). ePLND was omitted in one patient (1%) because of downgrading. For three patients (2%) a non–nerve-sparing procedure was planned after upgrading of the initial grade group. For four patients (3%), a unilateral nerve-sparing procedure was performed after downgrading.
Conclusions
This study shows that there is large interobserver agreement between uropathologists in the assessment of Gleason grade group in prostate biopsy specimens. Reassessment rarely leads to a change in surgical plan regarding the indication for a nerve-sparing approach and ePLND. Therefore, reassessment of prostate biopsy before radical prostatectomy can be omitted when the initial pathological assessment was performed by a dedicated uropathologist.
Patient summary
Reassessment of the initial prostate biopsy specimen for patients referred to a specialist center for robot-assisted removal of the prostate rarely influences surgical planning and can be omitted.
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