Radical prostatectomy specimens among Medicare patients in New York State: a review of pathologists' reports

Gross and microscopic pathologic examinations of radical prostatectomy specimens should result in reports that contain comprehensive information. Such information is important for facilitating adjuvant therapy decisions, assessing treatment interventions, providing patients and their families with estimates of prognosis, and in analyzing clinical outcomes. An important element of the information in radical prostatectomy specimen reports is the tumor status of margins, which is essential for staging.

The purposes of this study were to analyze the gross and microscopic examinations documented in a sample of radical prostatectomy reports and, by doing so, to determine the comprehensiveness of these reports.

The pathology reports from 414 charts of male Medicare patients aged 70 years and older who underwent radical prostatectomy in the 3-year period between 1991 and 1993 in New York State were examined. This group included all patients 75 years and older and a random sample of the 1266 patients aged 70 to 74 years who had undergone the procedure during the 3-year time frame. A protocol was used for recording general information from each pathology report as well as data relevant to gross and microscopic examinations.

The results of this study demonstrated an absence of uniformity in reporting protocols, as well as documentation problems in those protocols used. Important information concerning both the gross and microscopic examinations was frequently absent. An important finding of the study was the high level (94.9%) of reporting on the microscopic status of prostate gland margins, which permitted an accurate assessment of margin positivity. Among those cases for which margin status was reported, 54% were found to be tumor positive. This is a significant finding in that it has implications for TNM staging. Such patients have an increased risk of disease progression and have been shown to have the same 5-year mortality rate as patients who have not been treated surgically.

The study demonstrated a lack of uniformity in the pathology protocols used to describe radical prostatectomy specimens and the frequent absence of important gross and microscopic information. The results of this study also demonstrated a high rate (54%) of margin positivity among elderly men undergoing radical prostatectomy. Based on the results of this study, there is a need for closer attention to the issue of margin positivity. There is also a need for considering the usefulness of standardized reporting that includes elements with proven, putative, or prognostic value.