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Difference between revisions of "Radical prostatectomy"
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*Prostate dimensions (superior-inferior, left-to-right, anterior-posterior): ___ x ___ x ___ cm. | *Prostate dimensions (superior-inferior, left-to-right, anterior-posterior): ___ x ___ x ___ cm. | ||
*Seminal vesicles: | *Seminal vesicles: | ||
**Left (superior-inferior (long axis) | **Left (superior-inferior (long axis), left-to-right, anterior-posterior): ___ cm. | ||
**Right (superior-inferior (long axis) | **Right (superior-inferior (long axis), left-to-right, anterior-posterior): ___ cm. | ||
*Inking scheme: | *Inking scheme: green - anterior prostate, blue - right prostate, black - left prostate. | ||
Submitted in total: | |||
*All lymph nodes and the adherent adipose tissue. | *All lymph nodes and the adherent adipose tissue. | ||
*Urethral margin left. | *Urethral margin left. | ||
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====Procedural==== | ====Procedural==== | ||
#Amputate seminal vesicles (SV) after inking. | #Amputate seminal vesicles (SV) after inking. | ||
#*Sections of the SV base should be cut perpendicular the (long) axis of the gland. | #*Sections of the SV base (from the amputated SV) should be cut perpendicular the (long) axis of the gland. | ||
#Bladder neck margin is submitted on edge. | #Bladder neck margin is submitted on edge. | ||
#*A slice is cut-off the prostate at the site of the bladder neck margin. This slice is then divided into left and right with a sagittal cut. Each portion (left and right) is sectioned with parasagittal cuts such that it is submitted as an [[on edge margin]]. | #*A slice is cut-off the prostate at the site of the bladder neck margin. This slice is then divided into left and right with a sagittal cut. Each portion (left and right) is sectioned with parasagittal cuts such that it is submitted as an [[on edge margin]]. | ||
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**The prostate should be weighted after trimming the seminal vesicles. | **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). | **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 | *[[Lymph node]]s:<ref name=pmid20818343>{{Cite journal | last1 = Berney | first1 = DM. | last2 = Wheeler | first2 = TM. | last3 = Grignon | first3 = DJ. | last4 = Epstein | first4 = JI. | last5 = Griffiths | first5 = DF. | last6 = Humphrey | first6 = PA. | last7 = van der Kwast | first7 = T. | last8 = Montironi | first8 = R. | last9 = Delahunt | first9 = B. | title = International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes. | journal = Mod Pathol | volume = 24 | issue = 1 | pages = 39-47 | month = Jan | year = 2011 | doi = 10.1038/modpathol.2010.160 | PMID = 20818343 }}</ref> | ||
**All lymph nodes should be submitted. | **All lymph nodes should be submitted. | ||
***Metastases are found in over 5% of tissue not grossly recognized as a lymph node;<ref name=pmid3773097>{{Cite journal | last1 = Epstein | first1 = JI. | last2 = Oesterling | first2 = JE. | last3 = Eggleston | first3 = JC. | last4 = Walsh | first4 = PC. | title = Frozen section detection of lymph node metastases in prostatic carcinoma: accuracy in grossly uninvolved pelvic lymphadenectomy specimens. | journal = J Urol | volume = 136 | issue = 6 | pages = 1234-7 | month = Dec | year = 1986 | doi = | PMID = 3773097 }}</ref> thus, it | ***59% of the the ISUP consensus conference participants believe submitting all of the the lymph nodes (without the surrounding fat) is sufficient.<ref name=pmid20818343/> | ||
**The base of the SV | ***[[Lymph node metastasis|Metastases]] are found in over 5% of tissue not grossly recognized as a lymph node (at frozen section);<ref name=pmid3773097>{{Cite journal | last1 = Epstein | first1 = JI. | last2 = Oesterling | first2 = JE. | last3 = Eggleston | first3 = JC. | last4 = Walsh | first4 = PC. | title = Frozen section detection of lymph node metastases in prostatic carcinoma: accuracy in grossly uninvolved pelvic lymphadenectomy specimens. | journal = J Urol | volume = 136 | issue = 6 | pages = 1234-7 | month = Dec | year = 1986 | doi = | PMID = 3773097 }}</ref> thus, it is reasonable to submit all of the tissue.<ref>{{Cite journal | last1 = Sung | first1 = MT. | last2 = davidson | first2 = DD. | last3 = Montironi | first3 = R. | last4 = Lopez-Beltran | first4 = A. | last5 = Cheng | first4 = L. | title = Radical prostatectomy specimen processing: a critical appraisal of sampling methods. | journal = Current Diagnostic Pathology | volume = 13 | issue = | pages = 490-498 | month = | year = 2007 | doi = | PMID = | URL = http://www.journals.elsevierhealth.com/periodicals/ycdip/article/S0968-6053(07)00074-9/abstract }} </ref> | ||
*Seminal vesicles (SV):<ref name=pmid20818343/> | |||
**The base of the SV (adjacent to SV-prostate junction) must be submitted. | |||
***Only ''extraprostatic seminal vesicle involvement'' is considered ''seminal vesicle invasion''. | |||
***SV does ''not'' have to be [[submitted in total]]. | ***SV does ''not'' have to be [[submitted in total]]. | ||
===Alternate approaches=== | ===Alternate approaches=== | ||
* | *Does not have to be [[submitted in total]] - see ''literature'' section above. | ||
==See also== | ==See also== | ||
*[[Prostate specimens]]. | |||
===Related protocols=== | ===Related protocols=== | ||
*[[Prostate biopsy]]. | *[[Prostate biopsy]]. | ||
*[[Prostate chips]]. | |||
*[[Cystoprostatectomy]]. | |||
*[[Simple prostatectomy]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||