Pathology

There is significant variation across Scotland in the way that prostate biopsies are received by pathology departments from clinicians. Differences in equipment and training allow, for example, targeted fusion biopsies in some centres and not others. There will therefore be some inherent variability in the cellular pathology reports which are produced to capture the nuances of outcomes in relation to this.  

However, there was agreement that all centres continue to capture all the data required by the Royal College of Pathologists (RCPath) dataset for histopathology reports for prostatic carcinoma, including presence or absence of cribriform Gleason pattern 4 disease, and the percentage of Gleason pattern 4 disease present in Grade Group 2 and Grade Group 3 carcinoma. 

The most up to date RCPath guidelines for reporting prostate carcinoma were recently published in October 2024. All of the above recommendations are included, along with further guidance on how to assess the burden of disease, including prevention of overestimating tumour burden by considering targeted cores as a single core in the overall count of positive biopsies. The most up to date guidelines are appended below. 

Some somatic BRCA testing is currently available for patients with castrate resistant metastatic prostate cancer who may be considered for olaparib monotherapy. National discussions are ongoing regarding a formalised pathway which will include details about the tests and their timing. This CMP will be updated when formalised pathways are finalised.