A contemporary update on pathology reporting for prostate cancer: biopsy and radical prostatectomy specimens

Context

The diagnosis of and reporting parameters for prostate cancer (PCa) have evolved over time, yet they remain key components in predicting clinical outcomes.

Objective

Update pathology reporting standards for PCa.

Evidence acquisition

A thorough literature review was performed for articles discussing PCa handling, grading, staging, and reporting published as of September 15, 2011. Electronic articles published ahead of print were also considered. Proceedings of recent international conferences addressing these areas were extensively reviewed.

Evidence synthesis

Two main areas of reporting were examined: (1) prostatic needle biopsy, including handling, contemporary Gleason grading, extent of involvement, and high-risk lesions/precursors and (2) radical prostatectomy (RP), including sectioning, multifocality, Gleason grading, staging of organ-confined and extraprostatic disease, lymph node involvement, tumor volume, and lymphovascular invasion. For each category, consensus views, controversial areas, and clinical import were reviewed.

Conclusions

Modern prostate needle biopsy and RP reports are extremely detailed so as to maximize clinical utility. Accurate diagnosis of cancer-specific features requires up-to-date knowledge of grading, quantitation, and staging criteria. While some areas remain controversial, efforts to codify existing knowledge have had a significant impact on pathology practice.     

The distribution of residual cancer in radical prostatectomy specimens in stage A prostate cancer

To assess the volume and distribution of residual cancer after transurethral resection of the prostate in stage A cancer patients 42 step-sectioned radical prostatectomy specimens were examined, and the volume, location, grade and extracapsular extension of the residual tumor were recorded. A total of 13 patients had stage A1 tumors (5% or less tumor in the transurethral resection specimen and a Gleason sum of 7 or less) and 29 had stage A2 disease. Residual cancer was present in the radical prostatectomy specimen in 41 patients (98%) with a mean volume of 1.28 cc. The location of residual cancer, that is multifocal (76%), peripheral (81%) and distal to the verumontanum (66%), makes complete removal or even identification of residual tumor (restaging) by repeat transurethral resection improbable. Of the stage A1 cancer patients 4 (30%) had more than 1 cc residual tumor volume, extracapsular extension or seminal vesicle invasion. On the other hand, 14 of the stage A2 cancer patients (48%) had less than 1 cc residual tumor completely confined to the gland. Foci of residual cancer were found in the transition zone in 67% and in the peripheral zone in 90% of the patients. The grade of the residual peripheral zone cancer was significantly higher than that of the transition zone cancer in the same gland (p = 0.0004). Eight of 13 instances of extracapsular extension and all 5 of seminal vesicle invasion were directly attributable to peripheral zone cancer. These observations imply that the greatest threat to patients with stage A prostate cancer may be a separate, associated cancer in the peripheral zone rather than the primary transition zone cancer incidentally removed at transurethral resection.     

Seminal vesicle-sparing perineal radical prostatectomy improves early functional results in patients with low-risk prostate cancer

OBJECTIVE: To report a new and improved seminal vesicle-sparing (SV) technique of radical perineal prostatectomy (RPP) as an option for patients with localized prostate cancer, which is currently competing with the retropubic RP (RRP), endoscopic and robotic approaches. PATIENTS AND METHODS: From July 2003 to July 2006, 507 RPs were undertaken within a three-arm, unrandomized phase II trial. Patients were selected for RPP if they had a prostate-specific antigen (PSA) level of 相似文献   

Urodynamic changes in patients with prostate cancer undergoing robotic-assisted radical prostatectomy: A comparison with laparoscopic radical prostatectomy

ObjectiveThis study investigated the urinary incontinence status and urodynamic changes of localized prostate cancer patients after laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RaRP).Materials and methodsWe enrolled 36 and 30 patients who underwent LRP and RaRP, respectively. The urinary incontinence status and videourodynamic studies (VUDS) of the LRP and RaRP groups during the first year after the surgery were compared.ResultsThe RaRP group was younger and had a smaller prostate volume, shorter operation time, less blood loss, and higher proportion of patients who received postoperative radiotherapy than the LRP group. Twenty RaRP and 26 LRP patients completed VUDS during the 1-year follow-up. Overall, reduced detrusor voiding pressure (Pdet), increased maximal urinary flow rate (Qmax), and reduced bladder outlet obstruction index (BOOI) were detected at 3, 6, and 12 months postoperatively. At 12 months, both the LRP and RaRP groups had similar significant reductions of Pdet. However, only the RaRP group had a significant increase of Qmax and significant reduction of BOOI. Overall, 56.5% of patients (26 of 46) had detrusor overactivity (DO) before the surgery. The de novo DO rate and DO remission rate were 15.2% and 19.6%, respectively, without significant difference between the LRP and RaRP groups. At 6 months, the RaRP group had a significantly lower rate of stress urinary incontinence (SUI) than the LRP group (4.5% versus 47.2%, p = 0.003). In the RaRP group, the greater degree of recovery of both stress and urgency urinary continence developed during the first 6 months postoperatively.ConclusionThe changes of VUDS at 12 months postoperatively for radical prostatectomy included reduced Pdet and BOOI, and increased Qmax. At 6 months, the RaRP group had a lower SUI rate then the LRP group. The key phase of urinary continence recovery was the first 6 months after the surgery.     

Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study

Only 54% of prostate cancer cases in Korea are localized compared with 82% of cases in the US. Furthermore, half of Korean patients are upgraded after radical prostatectomy (41.6%–50.6%). We investigated the risk factors for upgrading and/or upstaging of low-risk prostate cancer after radical prostatectomy. We retrospectively reviewed the medical records of 1159 patients who underwent radical prostatectomy at five hospitals in Honam Province. Preoperative data on standard clinicopathological parameters were collected. The radical prostatectomy specimens were graded and staged and we defined a “worsening prognosis” as a Gleason score ≥ 7 or upstaging to ≥ pT3. Multivariate logistic regression models were used to assess factors associated with postoperative pathological upstaging. Among the 1159 patients, 324 were classified into the clinically low-risk group, and 154 (47.5%) patients were either upgraded or upstaged. The multivariable analysis revealed that the preoperative serum prostate-specific antigen level (odds ratio [OR], 1.131; 95% confidence interval [CI], 1.007–1.271; P= 0.037), percent positive biopsy core (OR: 1.018; 95% CI: 1.002–1.035; P= 0.032), and small prostate volume (≤30 ml) (OR: 2.280; 95% CI: 1.351–3.848; P= 0.002) were predictive of a worsening prognosis. Overall, 47.5% of patients with low-risk disease were upstaged postoperatively. The current risk stratification criteria may be too relaxed for our study cohort.     

Outcomes of men on active surveillance for low-risk prostate cancer at a safety-net hospital

Purpose

To characterize demographic, disease, and cancer outcomes of men on active surveillance (AS) at a safety-net hospital and characterize those who were lost to follow-up (LTFU).