Radical prostatectomy

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

Introduction

Radical prostatectomies 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: green - anterior prostate, blue - right prostate, black - left prostate.

Submitted in total:

• All lymph nodes and the adherent adipose tissue.
• Urethral margin left.
• Urethral margin right.
• Bladder neck margin left.
• Bladder neck margin right.
• Left prostate anterior to posterior.
• Left seminal vesicle base to tip.
• Right prostate anterior to posterior.
• Right seminal vesicle base to tip.

Protocol notes

Procedural

1. Amputate seminal vesicles (SV) after inking.
   • Sections of the SV base (from the amputated SV) should be cut perpendicular the (long) axis of the gland.
2. 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.
3. Urethral margin is submitted on edge.
   • A slice is cut-off the prostate at the site of the urethral 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.

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:
  • All lymph nodes should be submitted.
    • 59% of the the ISUP consensus conference participants believe submitting all of the the lymph nodes (without the surrounding fat) is sufficient.
    • Metastases are found in over 5% of tissue not grossly recognized as a lymph node (at frozen section); thus, it is reasonable to submit all of the tissue.
• Seminal vesicles (SV):
  • 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.

Alternate approaches

• Does not have to be submitted in total - see literature section above.

See also

• Prostate specimens.

Related protocols

• Prostate biopsy.
• Prostate chips.
• Cystoprostatectomy.