Siedow M, Eisner M, Yaney A, et al. - At a single institution, secondary pathology review led to assignment of nearly one in five men with prostate cancer (18.7%) to a different NCCN risk group and also provision of potentially different treatment options. Findings show the importance of a secondary pathology review as well as its potential effect on radiation therapy recommendations.

• Most extensively employed method to evaluate prostate adenocarcinoma pathology is the Gleason scoring system; however, interobserver variability is significant.

• Analyzing retrospectively obtained data on 342 patients with prostate cancer, the impact of a secondary pathology review on radiation therapy treatment recommendations was investigated.

• Comparisons were performed between cases reviewed by genitourinary pathologist (GUP) vs reports from outside pathologists.

• In 12.28% and 26.02% of cases, primary Gleason score and secondary score were changed, respectively, and the total Gleason score was different in 29.24% of cases, 19.01% and 10.23% were downgraded and upgraded, respectively.

• The weighted kappa statistic was 0.759, and such an estimate comparing NCCN risk stratification was 0.802.

• In men with high risk disease, radiation therapy recommendations concerning brachytherapy boost and androgen deprivation therapy were impacted by secondary review.

• The highest Kappa statistic was obtained when GUP evaluated high-risk disease vs all other categories (κ = 0.823).