Handling and Pathology Reporting of Radical Prostatectomy Specimens

Histopathological findings after radiofrequency (RITA) treatment for prostate cancer

Radiofrequency interstitial tumor ablation (RITA) is a thermal ablation method that uses needles and low radiofrequency (RF) energy. The aim of our study was to evaluate the histopathology of thermal lesions induced by RF energy delivered interstitially in prostate cancer patients who subsequently underwent prostatectomy, and to determine the feasibility, effectiveness and safety of this new method in a pilot study.

Cancer progression after anterograde radical prostatectomy for pathologic Gleason score 8 to 10 and influence of concomitant variables

OBJECTIVES

To evaluate the outcome in patients with clinically localized prostate cancer and pathologic Gleason score 8 to 10 disease treated by anterograde radical prostatectomy, either alone for node-negative disease or with early hormonal therapy for node-positive disease, and to characterize the prognostic significance of other pathologic variables.

METHODS

A total of 729 patients underwent radical prostatectomy for clinically localized prostate cancer between 1989 and 2003. We identified 116 patients (15.9%) with specimen Gleason score 8 or greater. The mean follow-up was 48 months (range 6 to 145).

RESULTS

The 5-year biochemical-free survival rate for those with pT2, pT3a, and pT3b diseases was 100%, 65.1%, and 10.5%, respectively (P < or =0.05). The 5-year biochemical-free survival rate for those with specimen Gleason score 8 and 9 was 72.1% and 38.2%, respectively (P < or =0.05). The incidence of positive surgical margins was 14.6% and led to a high pT3a specimen-confined detection rate. The preoperative prostate-specific antigen level, primary Gleason pattern, and surgical margin status had no statistically significant impact on biochemical recurrence-free survival. The multivariate Cox model showed seminal vesicle invasion to be the only independent prognostic factor. The 3 and 5-year progression-free survival rate of the 45 node-positive patients was 72.6% and 60.5%, respectively.

CONCLUSIONS

Our findings emphasize the need for early diagnosis, which can make this disease curable by radical prostatectomy alone, and show that poorly differentiated prostate cancer that has invaded the capsule can be cured by surgery. Biochemical recurrence represented a common event in pT3b and Gleason score 9 disease, suggesting a possible role for early adjuvant treatment.

Current practice of Gleason grading of prostate carcinoma

The Gleason grading system remains one of the most powerful prognostic factors in prostate cancer and is the dominant method around the world in daily practice. It is based solely on the glandular architecture performed at low magnification. The Gleason grading system should be performed in needle core biopsies and radical prostatectomy specimens where it shows a reasonable degree of correlation between both specimens, and most importantly, it remains vital in the treatment decision-making process. This review summarizes the current status of Gleason grading in prostate cancer, incorporating recent proposals for the best contemporary practice of prostate cancer grading.

[Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy]

FUNDAMENTALS

Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy.

METHODS

Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies.

RESULTS

In 20 patients (7.6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as "minimal adenocarcinoma". These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng/ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN ?. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN ?), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p = 0.243).

SUMMARY

Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients.

Laparoscopic radical prostatectomy: Evaluation of specimen pathologic features to critically assess and modify surgical technique

OBJECTIVES

To evaluate laparoscopic radical prostatectomy (LRP) specimens for pathologic stage and the malignant and benign surgical margin status to determine areas for improvement in surgical technique. LRP is gaining significant attention as a viable alternative to retropubic radical prostatectomy.

METHODS

A total of 110 consecutive LRP specimens were retrospectively reviewed. A single experienced genitourinary pathologist examined all slides. In addition, exposure of benign glands at the inked margin was reported. Oncologic data were assessed by standard pathologic examination for stage, grade, and margin status. The pathologic data from year 1 (group 1, 52 patients) were compared with the data from subsequent years (group 2, 58 patients).

RESULTS

The overall positive surgical margin rate was 18.2% (13.5% for pT2 disease). Benign parenchymal exposure was identified in 16 patients (14.5%). Six of these patients had concomitant negative surgical margins for cancer. The positive margin rate for patients with Stage pT2 disease was 22.2% in group 1 and 5.9% in group 2. The positive margin rate was 34.8%, 13.6%, and 13.8% for bilateral, unilateral, and non-nerve-sparing procedures, respectively.

CONCLUSIONS

LRP offers comparable surgical margins to those of reported open prostatectomy series. Careful pathologic review provides feedback so that technique modifications can be implemented and the positive margin rates improved further. A low, but significant, positive margin or benign parenchymal exposure rate in pT2 disease indicates room for improvement in the surgical technique. The presence of benign glands at the inked margin is not routinely reported but does provide an additional parameter of surgical adequacy.

In vivo uptake of [11C]choline does not correlate with cell proliferation in human prostate cancer

PURPOSE

Prostate cancer is the second leading cause of death from cancer among US men. Positron emission tomography (PET) with [(11)C]choline has been shown to be useful in the staging and detection of prostate cancer. The background of the increased uptake of choline in human prostate cancer is not completely understood. The aim of this study was to prospectively investigate the relationship between the [(11)C]choline uptake and the cell proliferation in human prostate cancer.

METHODS

Prostate cancer tissue from 18 patients who had undergone a radical prostatectomy for histologically proven disease was studied. An [(11)C]choline PET scan was performed prior to surgery. Post-prostatectomy specimens were prepared and stained with the antibody MIB-1 for Ki-67, which depicts proliferation. Two independent observers counted the amount of stained nuclei per specimen.

RESULTS

Prostate cancer showed Ki-67 staining and high uptake of [(11)C]choline. Statistical analysis showed no significant correlation between [(11)C]choline uptake and Ki-67 staining (R=0.23; P=0.34). No significant relationships were found between the uptake of [(11)C]choline (SUV) and either preoperative PSA (R=0.14; P=0.55) or Gleason sum score (R=0.28; P=0.25).

CONCLUSION

In vivo uptake of [(11)C]choline does not correlate with cell proliferation in human prostate cancer as depicted by Ki-67. Our results suggest that a process other than proliferation is responsible for the uptake of [(11)C]choline in prostate cancer.

Intraoperative Frozen Section Diagnosis in Urological Oncology

The intraoperative frozen sections are indicated if the pathological findings change the surgical procedure. In urological oncology is not recommended, as a general attitude, in the tumor diagnosis/staging during the surgery. The assessment of the surgical margins is recommended in partial surgical resections but the literature discourages its systematic use in the radical surgical resections. The assessment of the lymph nodes is specially indicated in the penile cancer with intermediate or high risk and non-palpable nodes, and is debated its utility in non-palpable lymph nodes of cystectomies and prostatectomies.