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| Gross = usu. posterior aspect of the prostate - often not apparent at gross | | Gross = usu. posterior aspect of the prostate - often not apparent at gross | ||
| Grossing = [[prostate biopsy]], [[prostate chips]], [[radical prostatectomy]] | | Grossing = [[prostate biopsy]], [[prostate chips]], [[radical prostatectomy]] | ||
| Staging = [[prostate cancer staging]] | |||
| Site = [[prostate gland]] | | Site = [[prostate gland]] | ||
| Assdx = | | Assdx = | ||
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Clinical criteria: | Clinical criteria: | ||
*PSA <= 10 ng/mL.<ref name=pmid22314081/> | *PSA <= 10 ng/mL.<ref name=pmid22314081/> | ||
*Negative DRE. | |||
==Gross== | ==Gross== | ||
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Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles. | Memory device: '''AAABBRS''' = atrophy, adenosis, adenosis (sclerosing), basal cell hyperplasia, bulbourethral gland, radiation, seminal vesicles. | ||
===Prostatic adenocarcinoma variants that mimic benign | ===Situations where prostate adenocarcinoma may be missed=== | ||
*[[Atrophic prostate carcinoma]] | Key reasons for false negative prostate samples<ref>{{cite journal |authors=Yang C, Humphrey PA |title=False-Negative Histopathologic Diagnosis of Prostatic Adenocarcinoma |journal=Arch. Pathol. Lab. Med. |volume=144 |issue=3 |pages=326–334 |date=March 2020 |pmid=31729886 |doi=10.5858/arpa.2019-0456-RA |url=}}</ref>: | ||
*[[Pseudohyperplastic adenocarcinoma]] | *Tissue artefacts (try levels and/or IHC): | ||
*[[Foamy gland adenocarcinoma]] | **Crush artefact | ||
*[[PIN-like adenocarcinoma]] | **Thick sections | ||
**Aberrant H&E staining | |||
**Freezing artefact | |||
**Cautery | |||
*Minimal adenocarcinoma (less than 1mm long or involving less than 5% of a core biopsy): | |||
*Prostatic adenocarcinoma variants that mimic benign: | |||
**[[Atrophic prostate carcinoma]] | |||
**[[Pseudohyperplastic adenocarcinoma]] | |||
**[[Foamy gland adenocarcinoma]] | |||
**[[PIN-like adenocarcinoma]] | |||
**Microcystic adenocarcinoma | |||
*Single cells of Gleason 5 adenocarcinoma (missed or mistaken for lymphocytes; try IHC for cytokeratins, prostatic and/or hematologic markers) | |||
*Treatment effect (check clinical information and look for treatment effect in benign glands) | |||
===Prostate cancer grading=== | ===Prostate cancer grading=== | ||
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====Surgical margins==== | ====Surgical margins==== | ||
{{Main|Surgical margins}} | {{Main|Surgical margins}} | ||
*Positive is ''tumour touching ink''.† <ref name=pmid22578729>{{Cite journal | last1 = Lu | first1 = J. | last2 = Wirth | first2 = GJ. | last3 = Wu | first3 = S. | last4 = Chen | first4 = J. | last5 = Dahl | first5 = DM. | last6 = Olumi | first6 = AF. | last7 = Young | first7 = RH. | last8 = McDougal | first8 = WS. | last9 = Wu | first9 = CL. | title = A close surgical margin after radical prostatectomy is an independent predictor of recurrence. | journal = J Urol | volume = 188 | issue = 1 | pages = 91-7 | month = Jul | year = 2012 | doi = 10.1016/j.juro.2012.02.2565 | PMID = 22578729 }}</ref> | *Positive is ''tumour touching [[ink]]''.† <ref name=pmid22578729>{{Cite journal | last1 = Lu | first1 = J. | last2 = Wirth | first2 = GJ. | last3 = Wu | first3 = S. | last4 = Chen | first4 = J. | last5 = Dahl | first5 = DM. | last6 = Olumi | first6 = AF. | last7 = Young | first7 = RH. | last8 = McDougal | first8 = WS. | last9 = Wu | first9 = CL. | title = A close surgical margin after radical prostatectomy is an independent predictor of recurrence. | journal = J Urol | volume = 188 | issue = 1 | pages = 91-7 | month = Jul | year = 2012 | doi = 10.1016/j.juro.2012.02.2565 | PMID = 22578729 }}</ref> | ||
**"Close" margins (<0.1 mm) have an increased recurrence risk.<ref name=pmid22578729/> | **"Close" margins (<0.1 mm) have an increased recurrence risk.<ref name=pmid22578729/> | ||
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=====Bladder neck margin===== | =====Bladder neck margin===== | ||
{{Main|Bladder neck invasion}} | |||
:[[AKA]] ''invasion of the bladder neck''.<ref name=pmid19914651/> | :[[AKA]] ''invasion of the bladder neck''.<ref name=pmid19914651/> | ||
*Bladder neck margin positivity typically is '''pT3a'''.<ref name=pmid23225909>{{Cite journal | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }}</ref> | *Bladder neck margin positivity typically is '''pT3a'''.<ref name=pmid23225909>{{Cite journal | last1 = Chung | first1 = MS. | last2 = Lee | first2 = SH. | last3 = Lee | first3 = DH. | last4 = Chung | first4 = BH. | title = Evaluation of the 7th American Joint Committee on cancer TNM staging system for prostate cancer in point of classification of bladder neck invasion. | journal = Jpn J Clin Oncol | volume = 43 | issue = 2 | pages = 184-8 | month = Feb | year = 2013 | doi = 10.1093/jjco/hys196 | PMID = 23225909 }}</ref> | ||
*Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref> | *Seen in approximately 1% of prostatectomies.<ref name=pmid19914651>{{Cite journal | last1 = Pierorazio | first1 = PM. | last2 = Epstein | first2 = JI. | last3 = Humphreys | first3 = E. | last4 = Han | first4 = M. | last5 = Walsh | first5 = PC. | last6 = Partin | first6 = AW. | title = The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. | journal = J Urol | volume = 183 | issue = 1 | pages = 151-7 | month = Jan | year = 2010 | doi = 10.1016/j.juro.2009.08.138 | PMID = 19914651 }}</ref> | ||
====Extraprostatic extension==== | ====Extraprostatic extension==== | ||
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===Transurethral resection of prostate=== | ===Transurethral resection of prostate=== | ||
<pre> | |||
Prostate Tissue, Transurethral Resection of Prostate (TURP): | |||
- ADENOCARCINOMA, Gleason score 6/10 (3+3); | |||
-- Approximately 2% of tissue involved; | |||
-- Please see tumour summary. | |||
Comment: | |||
The World Health Organization (WHO) grade is: 1 out of 5. | |||
</pre> | |||
<pre> | |||
Prostate Tissue, Transurethral Resection of Prostate (TURP): | |||
- ADENOCARCINOMA, Gleason score 7/10 (3+4); | |||
-- Approximately 4% of tissue involved; | |||
-- Please see tumour summary. | |||
- Benign inflamed urothelium. | |||
Comment: | |||
The World Health Organization (WHO) grade is: 2 out of 5. Gleason pattern 3 represents 90% of the tumour, and Gleason pattern 4 represents 10% of the tumour. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF PROSTATE (TURP): | PROSTATE TISSUE, TRANSURETHRAL RESECTION OF PROSTATE (TURP): | ||
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==PIN-like prostatic ductal adenocarcinoma== | ==PIN-like prostatic ductal adenocarcinoma== | ||
{{Main|High-grade prostatic intraepithelial neoplasia-like ductal adenocarcinoma of the prostate}} | |||
==Foamy gland carcinoma== | ==Foamy gland carcinoma== | ||
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==Mucinous prostate carcinoma== | ==Mucinous prostate carcinoma== | ||
{{Main|Mucinous adenocarcinoma of the prostate}} | |||
==Pseudohyperplastic prostatic adenocarcinoma== | ==Pseudohyperplastic prostatic adenocarcinoma== | ||
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=Metastatic disease and other cancers of the prostate= | =Metastatic disease and other cancers of the prostate= | ||
==Urothelial carcinoma== | ==Urothelial carcinoma== | ||
{{Main|Urothelial carcinoma | {{Main|Urothelial carcinoma of the urethra}} | ||
=See also= | =See also= |
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