Evaluation of radical prostatectomy specimens. A comparative analysis of sampling methods

We evaluated 104 radical prostatectomies for clinical stage B (n = 93) and stage A (n = 11) prostate cancer. Seven (8%) stage B cases had no gross cancer. By submitting only gross stage B cancer along with standard sections of proximal and distal margins, base of seminal vesicles, and most apical section (next to distal margin), we identified 91% of capsular penetration and 96% of positive margins as compared with identification by complete microscopic examination. Although this method identified 100% capsular penetration and positive margins in stage A cases, 28% of all the cases were grossly normal. Stage A tumor was often difficult to identify because of its heterogeneous location, its gross similarity to nodular hyperplasia, and the confounding presence of post-transurethral resection scarring. In 98% of all stages B and A cases, this method identified to within 1, the Gleason sum of the totally embedded radical prostatectomy. Using this sampling method, key pathologic parameters were identified with an average of 13 blocks (range 7-36) as compared with totally embedding the prostate, using an average of 42 blocks (range 21-81). Based on our study and our understanding of stages A and B disease, we recommend that in grossly normal glands, alternate posterior sections (stage B) and alternate entire sections (stage A) be submitted. Use of this sampling method will achieve a greater uniformity in the processing of specimens and a more accurate pathologic analysis of radical prostatectomy specimens.