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Incidental Prostate Adenocarcinoma in Cystoprostatectomy Specimens: Partial Versus Complete Prostate Sampling
Emily R Filter1, Manal Y Gabril2, Jose A Gomez2
11 Pathology department, Victoria General Hospital, Halifax, Nova Scotia, Canada.
International Journal of Surgical Pathology
|April 7, 2017
Summary
Complete prostate sampling during radical cystoprostatectomy (RCP) improves the detection of clinically significant incidental prostate cancer (PCa). This approach ensures more accurate pathological assessment, aiding in better patient management.
Area of Science:
- Urology
- Pathology
- Oncology
Background:
- Incidental prostate cancer (PCa) detection rates in radical cystoprostatectomy (RCP) vary significantly (15-54%).
- Variability in PCa detection may stem from differing institutional protocols for prostate grossing.
- Prostate gland submission in RCP can be partial or complete, impacting incidental PCa detection.
Purpose of the Study:
- To compare the clinical significance of incidental PCa detected in RCP specimens based on partial versus complete prostate sampling.
- To evaluate the impact of prostate grossing protocols on the pathological assessment of incidental PCa.
Main Methods:
- Retrospective review of 158 radical cystoprostatectomy (RCP) cases.
- Pathological features of incidental prostate adenocarcinoma (PCa) were assessed in 72 identified cases.
- Features analyzed included Gleason score, margin status, extraprostatic extension (EPE), seminal vesicle invasion (SVI), PCa stage, and tumor volume.
Main Results:
- Of 72 incidental PCa cases, 21 (29.1%) were from partial sampling and 51 (70.8%) from complete sampling.
- Clinically significant findings like extraprostatic extension (EPE), positive margins, and seminal vesicle invasion (SVI) were more frequently identified in the complete sampling group.
- Higher Gleason scores (>7) were exclusively observed in the complete sampling group.
Conclusions:
- Complete prostate sampling in RCP specimens is recommended for optimal detection of clinically significant incidental PCa.
- Standardizing prostate grossing protocols in RCP may reduce variability in incidental PCa detection.
- Complete sampling facilitates a more thorough pathological evaluation, crucial for accurate staging and treatment planning.