Lymph node staging in prostate cancer: perspective for the pathologist

Area of Science:

• Urology
• Pathology
• Oncology

Background:

• Pelvic lymph node dissection (PLND) is the gold standard for nodal staging in localized prostate cancer.
• Accurate histopathological evaluation of PLND specimens is critical for staging and potential therapeutic benefits.
• Current lack of consensus and quality parameters hinders optimal processing and reporting of PLND specimens.

Purpose of the Study:

• To review key issues in lymph node staging for prostate cancer.
• To focus on the histopathological evaluation of resected nodal specimens from PLND.
• To promote discussion towards a standardized approach for PLND specimen processing and reporting.

Main Methods:

• Literature review and expert consensus discussion.
• Analysis of current practices in histopathological evaluation of PLND.
• Identification of areas lacking standardization and guidelines.

Main Results:

• Significant variability exists in the histopathological evaluation of PLND specimens.
• No established quality parameters or universal guidelines for PLND processing.
• Specific challenges exist for handling uncommon nodal specimens, such as those in the anterior fat pad.

Conclusions:

• A standardized approach to processing and reporting PLND specimens is essential for accurate prostate cancer staging.
• Development of quality parameters and guidelines is urgently needed.
• Further discussion and collaboration are required to achieve consensus in PLND evaluation.