In office labs run the spectrum. Many are high quality and practice appropriate medicine. Many do not. Some are staffed by dedicated GU pathologists. Some are staffed by pathologists who make diagnoses like "Gleason score 2 + 4 = 6."
Some in office labs have IPOX usage rates lower than average. Some are exceedingly higher than average.
Prostate cancer is a strange world that keeps changing, as to what is clinically critical. A lot of clinicians now will tell you they don't care about 3+3 cancer, they just use it to increase the risk of finding treatable cancer. So no, I have not done lookbacks on negative biopsies. I typically pull negative biopsies if a later one shows up with a significant cancer and I have yet to see any missed cases. I also look at all my cases twice anyway, for whatever that's worth. Everyone who does something a lot will develop a routine to make sure you don't take shortcuts and don't miss important stuff.
IPOX usage rate I track. ASAP rate I track. Rates of positive biopsies and ranges of scores I track.
I never do PTEN, ERG, or Ki-67. Molecular tests are rare requests. But they are "standard" at many places, and of dubious utility when used in that fashion. Significant cancers will declare themselves typically with appropriate clinical evaluation, attention, and follow up. MRI is becoming more important than just about any other test except PSA (still).
Many urologists will tell you that even Gleason 10 cancer is better to have than a T1 bladder cancer. More treatment options and often better prognosis, and less morbid.
Oh, and we do not reflex any urine to FISH at all. The clinicians will send a new specimen if and when they want it, which is typically after they do a cystoscopy and see nothing. Occasional patients get FISH ordered up front for various reasons.
