In the histomorphological grading of prostate carcinoma, pathologists have regularly assigned comparable scores for the architectural Gleason and the now-obsolete nuclear World Health Organization (WHO) grading systems. Although both systems demonstrate good correspondence between grade and survival, they are based on fundamentally different biological criteria. We tested the hypothesis that this apparent concurrence between the two grading systems originates from an interpretation bias in the minds of diagnostic pathologists, rather than reflecting a biological reality. Three pathologists graded 178 prostatectomy specimens, assigning Gleason and WHO scores on glass slides and on digital images of nuclei isolated out of their architectural context. The results were analysed with respect to interdependencies among the grading systems, to tumour recurrence (PSA relapse > 0.1 ng/ml at 48 months) and robust nuclear morphometry, as assessed by computer-assisted image analysis. WHO and Gleason grades were strongly correlated (r = 0.82) and demonstrated identical prognostic power. However, WHO grades correlated poorly with nuclear morphology (r = 0.19). Grading of nuclei isolated out of their architectural context significantly improved accuracy for nuclear morphology (r = 0.55), but the prognostic power was virtually lost. In conclusion, the architectural organization of a tumour, which the pathologist cannot avoid noticing during initial slide viewing at low magnification, unwittingly influences the subsequent nuclear grade assignment. In our study, the prognostic power of the WHO grading system was dependent on visual assessment of tumour growth pattern. We demonstrate for the first time the influence a cognitive bias can have in the generation of an error in diagnostic pathology and highlight a considerable problem in histopathological tumour grading.

Patients with unilateral Wilms tumor without metastasis have an excellent prognosis. The post-operative chemotherapy in stage I can be reduced to 4 weeks without worsening treatment outcome. The reduction of the tumor volume could be identified as a helpful marker for stratification of post-operative treatment. Post-chemotherapy blastemal predominant subtype of Wilms tumor has to be classified as high risk tumor. Focal anaplasia has a better prognosis than diffuse anaplasia and will be classified as intermediate risk tumor.

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Radical prostatectomy is the most frequently used treatment for localized prostate cancer. In contrast to other strategies radical prostatectomy has been shown to be superior to watchful waiting in a prospective randomized trial. According to the German S3 guideline patients have to be informed about the results of this trial prior to treatment decision. The aims and quality indicators of radical prostatectomy include--as has also been defined by the German Cancer Society for certified prostate cancer centers--complete removal of the prostate with negative surgical margins (R0) and preservation of continence as well as potency. In low-risk disease (according to D'Amico criteria) pelvic lymph node dissection may be abandoned. If lymphadenectomy is performed a minimum number of ten nodes should be obtained. An extended lymphadenectomy is recommended in locally advanced disease.Radical prostatectomy is a valid treatment option in locally advanced prostate cancer. In cases with Gleason score > or = 8 or clinical stage cT3/4 magnetic resonance imaging of the pelvis should be performed prior to treatment decision making. In patients undergoing radical prostatectomy (neo) adjuvant treatment should not be used (exception: adjuvant treatment for lymph node metastases). For the first time the German S3 guideline determines minimum surgery volumes aimed at quality assurance. Radical prostatectomy has to be performed under the supervision of an experienced surgeon. This includes the number of 50 prostatectomies per year and institution, 25 prostatectomies per surgeon, and an appropriate training program.

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