Prostatic Adenocarcinoma
Staging
- Needle biopsy considerations
- Record length of core involved by carcinoma and total length of core, in mm or give percent
- If foci are discontinuous, include the intervening normal tissue in the measurement (Schultz 2013, Arias-Stella 2015)
- Presence of carcinoma at the level of fat is diagnostic of extraprostatic extension
- Skeletal muscle may be seen in normal prostate and is not useful
- Perineural invasion indicates 95% probability of extraprostatic extension
- It should be reported for needle biopsy specimens
- Invasion of seminal vesicle – must rule out identical appearing ejaculatory ducts based on stated site of biopsy
- Transurethral resection considerations
- Evaluation of volume of carcinoma
- Stage T1a: 5% or fewer of chips involved, all grade 3 or lower
- (Counting chips is more practical than measuring area)
- Stage T1b: over 5% of chips involved or presence of any grade 4 or 5
- Entirely submit first 15 gm, then 1 cassette for each additional 5 grams up to 30 gm total, then 1 cassette for each additional 10 gm
- Prostatectomy considerations
- Evaluate for extraprostatic extension (EPE)
- Infiltration of fat is diagnostic of EPE
- Most commonly seen in posterior prostate
- Anterior periprostatic tissue has no fat
- Evaluation for EPE requires recognition of the contour of the limit of the normal prostatic glands
- The prostate should be differentially inked and sections taken in a manner that permits localization of the section
- EPE cannot be assessed in the apex as the capsule is very indistinct there
- Skeletal muscle is present in the apex and anterior prostate associated with normal glands and is not useful for assessing EPE
- Involvement of the base of the prostate is not EPE
- True seminal vesicle involvement requires invasion of wall, not just adventitia.
- Evaluation of margin is completely independent of EPE assessment
- Differential inking permits localization of positive margins
- The apex and base should each be amputated and sectioned perpendicularly to the surface
- Reporting of perineural involvement is not required for prostatectomies
- Multiple foci of carcinoma, if bilateral, are staged as pT2c (Andreolu 2010)
- Most truly multifocal carcinomas represent distinct clones
- Staged as bilateral involvement anyway
Navigation for This Section: Surgical Pathology Criteria
Additional Links: General Links
