Radical prostatectomy

This article deals with how to cut-up a radical prostatectomy, abbreviated RP.

Introduction

RPs are done for prostate cancer.

Protocol

Specimen:

• Weight of specimen: ___ grams.
• Prostate dimensions (superior-inferior, left-to-right, anterior-posterior): ___ x ___ x ___ cm.
• Seminal vesicles:
  • Left (superior-inferior (long axis), , left-to-right, anterior-posterior): ___ cm.
  • Right (superior-inferior (long axis), , left-to-right, anterior-posterior): ___ cm.
• Inking scheme: left - blue; right - green.

Protocol notes

Procedural

• Amputate seminal vesicles (SV) after inking.
• Sections of the SV base should be cut perpendicular the (long) axis of the gland.

Literature

There are several consensus papers on grossing prostatectomies by the International Society of Urological Pathology (ISUP).

• Prostate gland:
  • Embedding in toto is not required.
    • A study by Epstein suggests it is reasonable to submit all of the posterior aspect and selected sections from the mid portion.
  • The prostate should be painted -- to mark the margins.
  • Sectioning should be done after fixation.
  • The prostate should be weighted after trimming the seminal vesicles.
  • The apex of the prostate and the bladder neck should be sliced-off, sagittally sectioned, and submitted separately on edge (to assess the margin).
• Lymph nodes and seminal vesicles (SV):
  • All lymph nodes should be submitted.
    • Metastases are found in over 5% of tissue not grossly recognized as a lymph node; thus, it makes sense to submit all tissue.
  • The base of the SV/prostate junction must be submitted.
    • SV does not have to be submitted in total.

See also

Related protocols

• Prostate biopsy.