Printer Friendly
The Free Library
23,389,518 articles and books


Updated Protocol for the Examination of Specimens From Patients With Carcinomas of the Prostate Gland.

A Basis for Checklists

This protocol is intended to assist pathologists in providing clinically useful and relevant information as a result of the examination of surgical specimens. Use of this protocol is intended to be entirely voluntary. If equally valid protocols or similar documents are applicable, the pathologist is, of course, free to follow those authorities. Indeed, the ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of the individual circumstances presented by a specific patient or specimen.

It should be understood that adherence to this protocol will not guarantee a successful result. Nevertheless, pathologists are urged to familiarize themselves with the document. Should a physician choose to deviate from the protocol based on the circumstances of a particular patient or specimen, the physician is advised to make a contemporaneous written notation of the reason for the procedure followed.

The College recognizes that this document may be used by hospitals, attorneys, managed care organizations, insurance carriers, and other payers. However, the document was developed solely as a tool to assist pathologists in the diagnostic process by providing information that reflects the state of relevant medical knowledge at the time the protocol was first published. It was not developed for credentialing, litigation, or reimbursement purposes. The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document.

UPDATED PROTOCOL FOR THE EXAMINATION OF SPECIMENS FROM PATIENTS WITH CARCINOMAS OF THE PROSTATE GLAND

1. Needle Biopsy

A. Clinical information

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history (eg, urinary obstruction)

b. Relevant findings (eg, digital rectal examination, prostate-specific antigen, ultrasound, magnetic resonance imaging)

c. Clinical diagnosis (eg, carcinoma)

d. Procedure (eg, thick-core [14-gauge] transrectal or transperineal biopsy, thin-core [18-gauge] image-guided gun biopsies [sextant, octant, etc])

e. Specific site of needle biopsy (eg, peripheral zone, transition zone, apex, base, etc)

B. Macroscopic examination

1. Specimen

a. Number of pieces

b. Unfixed/fixed (specify fixative)

c. Dimensions

d. Orientation, if designated by surgeon

e. Results of intraoperative consultation

2. Tissue submitted for microscopic examination (eg, all tissue), frozen section tissue fragment(s), unless saved for special studies

3. Special studies (specify) (eg, histochemistry, immunohistochemistry, morphometry, DNA analysis, cytogenetic analysis)

C. Microscopic evaluation

1. Tumor

a. Histologic type (note A)

b. Gleason score with primary and secondary grades (note B)

c. Quantitation of tumor (eg, proportion [%] of prostatic tissue involved by neoplasm) (note C)

d. Local invasion (note D)

(1) Periprostatic fat

(2) Seminal vesicle

e. Perineural invasion (note E)

f. Blood/lymphatic vessel invasion

2. Additional pathologic findings, if present

a. High-grade prostatic intraepithelial neoplasia (note F)

b. Therapy-related changes

c. Other

3. Results/status of special studies (specify)

4. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

II. Transurethral Prostatic Resection

A. Clinical information

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history (eg, urinary obstruction)

b. Relevant findings (eg, digital rectal examination, prostate-specific antigen, ultrasound, magnetic resonance imaging)

c. Clinical diagnosis (eg, carcinoma)

d. Operative procedure (transurethral resection of prostate [TURP])

e. Operative findings

B. Macroscopic examination

1. Specimen

a. Organ(s)/tissues(s) included

b. Unfixed/fixed (specify fixative)

c. Weight

d. Descriptive features

e. Results of intraoperative consultation

2. Tissue submitted for microscopic examination (note G)

a. All grossly suspicious chips (note G)

b. Specimen [is less than or equal to] 12 g, submit entirely(*)

c. Specimen [is greater than] 12 g, submit at least 12 g (about 6-8 cassettes)(*)

d. Frozen section tissue fragment(s) (unless saved for special studies)

(*) Note: If an unsuspected carcinoma is found in tissue submitted and it involves [is less than or equal to] 5% of the tissue examined, all remaining tissue should be submitted for microscopic examination.

3. Special studies (specify)

C. Microscopic evaluation

1. Tumor

a. Histologic type (note A)

b. Gleason score with primary and secondary grades (note B)

c. Quantitation of tumor (note C)

d. Local invasion (note D)

(1) Periprostatic fat

(2) Seminal vesicle

e. Perineural invasion (note E)

f. Blood/lymphatic vessel invasion

2. Additional pathological findings, if present

a. Prostatic intraepithelial neoplasia (note F)

b. Atypical adenomatous hyperplasia

c. Therapy-related changes

d. Other(s)

3. Results of special studies

4. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

III. Suprapubic or Retropubic Enucleation (Subtotal Prostatectomy)

A. Clinical information

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history (eg, urinary obstruction)

b. Relevant findings (eg, palpable mass, elevated prostate-specific antigen, imaging)

c. Clinical diagnosis

d. Procedure (eg, enucleation)

e. Operative findings

B. Macroscopic examination

1. Specimen

a. Tissue(s)/organ(s) received

b. Unfixed/fixed (specify fixative)

c. Size (3 dimensions)

d. Weight

e. Descriptive features (eg, necrosis, nodular hyperplasia)

f. Orientation, if indicated by surgeon

g. Identification of margins

h. Results of intraoperative consultation

2. Tumor, if identified

a. Location(s)

b. Size(s)

c. Descriptive features

d. Extent of invasion (note H)

3. Blocks submitted for microscopic evaluation

a. Tumor or areas suspicious for tumor

b. Other representative blocks (approximately 8 cassettes)([dagger])

c. Frozen section tissue fragment(s) (unless saved for special studies)

([dagger]) Note: If an unsuspected carcinoma is found in tissue submitted and it involves 5% or less of the tissue examined, additional blocks should be submitted for microscopic analysis.

4. Special studies (specify)

C. Microscopic evaluation

1. Tumor

a. Histologic type (note A)

b. Gleason score with primary and secondary grades (note B)

c. Quantitation of tumor

(1) Size of tumor(s), 2 or more dimension(s)

(2) Proportion (%) of specimen involved by tumor

d. Location of tumor(s)

e. Local invasion (note H)

f. Perineural invasion (note E)

g. Blood/lymphatic vessel invasion

2. Margins

3. Additional pathologic findings, if present

a. High-grade prostatic intraepithelial neoplasia (note E)

b. Atypical adenomatous hyperplasia

c. Therapy-related changes

d. Other(s)

4. Results/status of special studies (specify)

5. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

IV. Radical Prostatectomy

A. Clinical information

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Clinical information

a. Relevant history (previous diagnosis, treatment, includes prostate-specific antigen, imaging)

b. Relevant clinical findings

c. Procedure

(1) Perineal procedure

(2) Retropubic procedure

i. Nerve sparing

ii. Standard radical

d. Operative findings

e. Anatomic site(s) of specimen(s)

B. Macroscopic examination

1. Specimen

a. Organ(s)/tissues included

b. Unfixed/fixed (specify fixative)

c. Opened/unopened

d. Orientation, if indicated by surgeon

e. Structures included in specimen

(1) Prostate

(2) Seminal vesicles

(3) Segments of vasa deferentia

(4) Bladder neck

(5) Urethra

(6) Other(s) (specify)

f. Size (3 dimensions)

g. Weight (prostate separately)

h. Obstruction of urethra (partial/complete)

i. Descriptive features (eg, necrosis, nodular hyperplasia)

j. Results of intraoperative consultation

2. Tumor(s), if identified

a. Location(s)

b. Size(s)

c. Descriptive features

d. Extent of local invasion

3. Regional lymph nodes

a. Location

b. Number (each location, if possible)

4. Blocks submitted for microscopic evaluation (include diagrams, if appropriate) (note G)

a. Tumor(s) (each grossly recognizable tumor)

b. Blocks from other anatomic locations within the prostate (to evaluate for multicentricity)

c. Blocks to determine extent of invasion (note H)

(1) Prostatic capsule and periprostatic tissue adjacent to each tumor, including inked margins

(2) Seminal vesicles

(3) Periprostatic tissue at bases of seminal vesicles

d. Apex (note J)

e. Vesical neck margin (note J)

f. All lymph nodes

g. Frozen section tissue fragment(s) (unless saved for special studies)

h. Other tissues (specify)

5. Special studies (specify) (eg, immunohistochemistry, ploidy analysis, S-phase fraction)

C. Microscopic evaluation

1. Tumor

a. Histologic type (note A)

b. Gleason score with primary and secondary grades (note B)

c. Location(s)

d. Extent of local invasion (note H)

(1) Extraprostatic extension

(2) Seminal vesicle involvement

2. Margins (location and extent of margins involved with tumor) (see note I)

3. Regional lymph nodes

a. Number (specify location)

b. Number involved by tumor

(1) Specify location, if possible

(2) Size of metastatic deposit (eg, if [is less than] 2 mm = micrometastasis)

(3) Extracapsular extension, if present

4. Additional pathologic findings, if present

a. High-grade intraepithelial neoplasia

b. Therapy-related changes

c. Other(s)

5. Metastasis to other organ(s) or structure(s) (specify sites)

6. Other tissue(s)/organ(s)

7. Results/status of special studies (specify)

8. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

EXPLANATORY NOTES

A: Histologic Type.--This protocol applies only to carcinomas of the prostate gland. The Histologic Classification of Prostate Carcinoma is recommended as shown below.[1] However, this protocol does not preclude the use of other systems of classification or histologic types. Mixtures of different histologic types should be indicated.

Histologic Classification of Carcinoma of the Prostate Adenocarcinoma (conventional, not otherwise specified) Special variants of adenocarcinoma and other carcinomas

Prostatic duct adenocarcinoma

Mucinous (colloid) adenocarcinoma

Signet ring cell carcinoma

Adenosquamous carcinoma

Squamous cell carcinoma

Basaloid and adenoid cystic carcinoma

Transitional cell carcinoma

Small cell carcinoma

Sarcomatoid carcinoma

Lymphoepithelioma-like carcinoma

Undifferentiated carcinoma, not otherwise specified

B: Gleason Score.--The Gleason grading system is recommended for use in all prostatic cancer specimens.[2-6] The Gleason score is the sum of the primary (most predominant) Gleason grade and the secondary (second most predominant) Gleason grade. Where no secondary Gleason grade exists, the primary Gleason grade is doubled to arrive at a Gleason score. The primary and secondary grades should be reported in parentheses after the Gleason score, that is, Gleason score 7(3,4) or 7(3+4). In needle biopsy specimens in which more than 2 patterns are present and the worst grade is neither the predominant nor the secondary grade, the predominant and the highest grade should be chosen to arrive at a score (eg, 60% grade 3, 30% grade 2, 10% grade 4 is scored as 3 + 4 = 7). When multiple needle biopsy specimens are submitted and they have differing Gleason scores, an overall (composite) Gleason score for the case should be clearly reported in a note.

In radical prostatectomy specimens in which more than 1 separate tumor is identified, the Gleason scores of the individual tumors may be reported separately, or at the very least the Gleason score of the most significant lesion should be recorded. For instance, if there is a large Gleason score 5 transition zone cancer and a separate smaller Gleason score 7 peripheral zone cancer, both scores or at least the latter score should be reported rather than the scores being averaged.

Another grading system may be used according to institutional preference (eg, World Health Organization, M. D. Anderson), but the Gleason score must be included to facilitate comparison of data.
Gleason Grades (Patterns)

Grade 1 Single, separate, closely packed acini

Grade 2 Single acini, more loosely arranged, less uniform

Grade 3 Single acini of variable size, and separation,
 cribriform and papillary patterns

Grade 4 Irregular masses of acini and fused epithelium,
 can show clear cells

Grade 5 Anaplastic carcinoma

Gleason scores may be grouped into differentiation
(prognostic) categories:

2-4 Well differentiated
5-6 Moderately well differentiated
7 Moderately poorly differentiated
8-10 Poorly differentiated

or

2-6 Well differentiated
7 Moderately differentiated
8-10 Poorly differentiated


C: Quantitation of Tumor.--There are many methods of estimating the amount of tumor in prostatic specimens.[7-16] In core biopsies, the absolute number or percentage of cores involved, the linear extent of involvement in millimeters, and the proportion (percent) of surface area of prostatic tissue involved may be used. In transurethral resectates, the proportion (percent) of tissue involved by carcinoma and the number of positive chips (foci) may be used. In subtotal and radical prostatectomy specimens, the percentage of tissue involved by tumor can also be "eyeballed." Additionally, in these latter specimens it may be possible to measure a dominant tumor nodule in at least 2 dimensions and to indicate the number of blocks involved by tumor over the total number of prostatic blocks submitted.

For the purpose of this protocol it is recommended that at the very least, the proportion (percent) of prostatic tissue involved by tumor be included for all specimens.

D: Local Invasion in Needle Biopsies.--Occasionally in needle biopsies, periprostatic fat is present and involved by tumor.[7-9] This observation should be noted since it indicates that the tumor is at least stage pT3a. Furthermore, if seminal vesicle tissue is present (either unintentionally or intentionally as in a directed biopsy) and is involved by tumor, this should be reported since it indicates that the tumor is at least stage pT3b. Seminal vesicle invasion is defined by involvement of the muscular wall.[7-9,17] At times, especially in needle biopsy specimens, it is difficult to distinguish between seminal vesicle and ejaculatory duct-type tissue. It is important not to overinterpret ejaculatory duct as seminal vesicle-type tissue. Ejaculatory duct epithelium is generally surrounded by loose fibrous connective tissue with abundant blood vessels, whereas the seminal vesicle epithelium is surrounded by smooth muscle bundles constituting its wall.

E: Perineural Invasion.--Perineural invasion on core needle biopsies has been associated with a high risk of extraprostatic extension in some studies, although the exact prognostic significance remains to be determined.[18-21] Perineural invasion has also been found to be an independent risk factor for predicting an adverse outcome in patients treated with external beam radiation.[18] The value of perineural invasion as an independent prognostic factor, however, has been questioned in a multivariate analysis.[22]

F: Prostatic Intraepithelial Neoplasia.--The diagnostic term prostatic intraepithelial neoplasia (PIN), unless qualified, refers to high-grade PIN.[23] Low-grade PIN is generally not reported. The presence of PIN should be reported in all biopsy specimens, including those with carcinoma.[9] High-grade PIN in a biopsy without evidence of carcinoma is a significant risk factor for the presence of carcinoma on subsequent biopsies.[24,25] The reporting of high-grade PIN in prostatectomy specimens is optional.

G: Submission of Tissue for Microscopic Evaluation in Transurethral Resection and Radical Prostatectomy Specimens.--Specimens weighing less than 12 g should be submitted in their entirety, usually in 6 to 8 cassettes.[26,27] For specimens greater than 12 g, the initial 12 g are submitted (6-8 cassettes), and 1 cassette for every additional 5 g may be submitted.

In general random chips are submitted; however, if some chips are firmer or have a yellow or orange-yellow appearance, they should be preferentially submitted.

In radical prostatectomy specimens with no grossly visible tumor, the specimen may be submitted in its entirety or partially sampled in a systematic fashion. One method of partial sampling involves submitting the entire apical segment and bladder neck along with alternating posterior transverse sections. Two or three random blocks demonstrating the anterior surface are also submitted along with samples of each seminal vesicle, including their juncture with prostate proper.

H: Extraprostatic Extension.--Extraprostatic extension is the preferred term for the presence of tumor beyond the confines of the prostate gland.[8,28] Tumor abutting on or admixed with fat constitutes extraprostatic extension. Extraprostatic extension may also be reported when tumor involves perineural spaces in the neurovascular bundles, even in the absence of periprostatic fat involvement. In certain locations, such as the anterior prostate and bladder neck regions, there is a paucity of fat, and in these locations extraprostatic extension is determined when the tumor extends beyond the confines of the normal glandular prostate. Sometimes there is a distinct bulging tumor nodule that may be associated with a desmoplastic stromal reaction.

I: Margins.--The entire surface of the prostate should be inked to evaluate the surgical margins.[29-36] Usually, surgical margins should be designated as "negative" if tumor is not present at the inked margin and as "positive" if tumor cells touch the ink at the margin. Positive surgical margins should not be interpreted as extraprostatic extension. If the surgical margin is positive, the pathologist should state this explicitly, although this finding is not relied on for pathologic staging. The specific locations of the positive margins should be documented, and there should be some indication (eg, number of positive blocks, linear extent in millimeters) of the extent of margin positivity.

J: Apex and Bladder Neck.--The apex should be closely examined because of its unusual susceptibility to positive margins.[29-31] At the apex, tumor admixed with skeletal muscle elements does not constitute extraprostatic extension. The apical and bladder neck surgical margins should be sectioned entirely, preferably with a perpendicular orientation. Microscopic involvement of bladder neck muscle fibers in radical prostatectomy specimens should not be equated with a pT4 designation. The latter generally requires gross involvement of the bladder neck.

K: TNM and Stage Groupings.--The protocol recommends the use of the TNM Staging System for carcinoma of the prostate of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) as shown below.[37,38]

By AJCC/UICC convention, the designation "T" of the TNM classification refers exclusively to the first resection of a primary tumor The prefix symbol "p" refers to the pathologic classification of the TNM (pTNM), as opposed to the clinical classification. Pathologic classification is based on gross and microscopic examination. Therefore, pT entails a resection of the primary tumor or biopsy adequate to evaluate the highest pT category, pN entails removal of nodes adequate to validate lymph node metastasis, and pM implies microscopic examination of distant lesions. Clinical classification (cTNM) is usually carried out by the referring physician before treatment during initial evaluation of the patient or when pathologic classification is not possible.

The absence or presence of residual tumor following preoperative, nonsurgical therapy (eg, chemotherapy and/or radiation treatment) may be described by the symbol "R" and classified as follows:
RX Residual tumor cannot be assessed
R0 No residual tumor
R1 Microscopic residual tumor
R2 Macroscopic residual tumor


If residual tumor is present, its extent may be documented by the TNM classification preceded by the symbol "y" (eg, ypT1).

Local recurrence following a previous resection should be classified as listed above with the prefix "r" (eg, rpT1).
Primary Tumor, Clinical (cT)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

T1 Clinically inapparent tumor not palpable or visible
 by imaging

 T1a Tumor incidental histologic finding in 5% or
 less of tissue resected

 T1b Tumor incidental histologic finding in more
 than 5% of tissue resected

 T1c Tumor identified by needle biopsy (eg, because
 of elevated prostate-specific antigen)

T2 Tumor confined within the prostate(*)

 T2a Tumor involves one lobe

 T2b Tumor involves both lobes

T3 Tumor extends through the prostatic capsule([dagger])

 T3a Extracapsular extension (unilateral or bilateral)

 T3b Tumor invades the seminal vesicle(s)

T4 Tumor is fixed or invades adjacent structures other
 than the seminal vesicles, bladder neck, external
 sphincter, rectum, levator muscles, and/or pelvic
 wall


(*) Tumor found in one or both lobes by needle biopsy, but that is not palpable or visible by imaging, is classified as T1c.

([dagger]) Invasion into the prostatic apex or into (but not beyond) the prostatic capsule is not classified as T3, but as T2. Tumor extension into periprostatic soft tissue, as opposed to organ-confined cancer (T2), is classified as T3.
Primary Tumor, Pathologic (pT)

pT2(*) Organ confined
 pT2a Unilateral
 pT2b Bilateral

pT3 Extraprostatic extension
 pT3a Extraprostatic extension
 pT3b Seminal vesicle extension

pT4([dagger]) Invasion of bladder, rectum


(*) There is no pathologic T1 category.

([dagger]) Invasion of bladder indicates direct spread into the wall of the urinary bladder. The basal prostatic stroma blends imperceptibly into the bladder neck musculature, and in most instances involvement of the bladder neck margin in a radical prostatectomy does not indicate that the tumor is pT4.
Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional lymph node or nodes

Distant Metastasis(*) (M)

MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

 M1a Nonregional lymph node(s)
 M1b Bone(s)
 M1c Other site(s)


(*) When more than 1 site of metastasis is present, the most advanced category (pM1c) is used.
Stage Groupings (TNM) Grade

Stage I T1a N0 M0 G1
Stage II T1a N0 M0 G2, G3-4
 T1b N0 M0 Any G
 T1c N0 M0 Any G
 T1 N0 M0 Any G
 T2 N0 M0 Any G
Stage III T3 N0 M0 Any G
Stage IV T4 N0 M0 Any G
 Any T N1 M0 Any G
 Any T Any N M1 Any G


References

[1.] Young RH, Srigley JR, Amin MB, Ulbright TM, Cubilla A. Tumors of the Prostate Gland, Seminal Vesicle, Male Urethra and Penis. Washington, DC: Armed Forces Institute of Pathology. Atlas of Tumor Pathology; 3rd series. In press.

[2.] Gleason DR, Mellinger GT, the Veterans Administration Cooperative Urological Research Group. Prediction of prognosis for prostate adenocarcinoma by combined histological grading and clinical staging. J Urol. 1974;111:58-64.

[3.] Gleason DF. Histologic grading of prostate cancer: a perspective. Hum Pathol. 1992;23:273-279.

[4.] Bostwick DG. Gleason grading of prostatic needle biopsies: correlation with grade in 316 matched prostatectomies. Am J Surg Pathol. 1994;18:796-803.

[5.] Steinberg DM, Sauvageot J, Piantadosi S, Epstein JI. Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol. 1997;21:566-576.

[6.] Partin AW, Kattan MW, Subong ENP, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional update. JAMA. 1997;277:1445-1451.

[7.] Epstein JI. The diagnosis and reporting of adenocarcinoma of the prostate in core needle biopsy specimens. Cancer. 1996;78:350-356.

[8.] Amin MB, Grignon D, Bostwick D, et al. Recommendations for reporting resected prostatic carcinomas with commentary. Pathol Case Rev. 1998;3:223-232.

[9.] Bostwick DG. Evaluating prostate needle biopsy: therapeutic and prognostic importance. CA Cancer J Clin. 1997;47:297-319.

[10.] Cupp MR, Bostwick DG, Myers RP, Oesterling JE. The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy on an individual basis. J Urol. 1995;153:1543-1548.

[11.] Peller PA, Young DC, Marmaduke DP, et al. Sextant prostate biopsies: a histopathologic correlation with radical prostatectomy specimens. Cancer. 1995; 75:530-538.

[12.] Ravery V, Boccon-Gibod LA, Dauge-Geffroy, et al. Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistent/recurrent detectable PSA after radical prostatectomy. Urology. 1994;44:371-376.

[13.] Ravery V, Schmid HP, Toublanc M, Boccon-Gibod L. Is the percentage of cancer in biopsy cores predictive of extracapsular disease in T1-T2 prostate carcinoma? Cancer. 1996;78:1079-1084.

[14.] Terris MK, Haney DJ, Johnstone IM, et al. Prediction of prostate cancer volume using prostate specific antigen levels, transrectal ultrasound, and systematic sextant biopsies. Urology. 1995;45:75-80.

[15.] Stamey TA, Freiha FS, McNeal JE, et al. Localized prostate cancer: relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer. 1993;71;933-938.

[16.] Humphrey PA, Vollmer RT. Percentage carcinoma as a measure of prostatic tumor size in radical prostatectomy tissues. Mod Pathol. 1997;10:326-333.

[17.] Ohori M, Scardino PT, Lapin SL, Seale-Hawkins C, Link J, Wheeler TM. The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer. Am J Surg Pathol. 1993;17:1252-1261.

[18.] Anderson PR, Hanlon Al, Patchefsky A, Al-Saleem T, Hanks GE. Perineural invasion and Gleason 7-10 tumors predict increased failure in prostate cancer patients with pretreatment PSA [is less than] 10 ng/ml treated with conformal external beam radiation therapy. Int J Radiat Oncol Biol Phys. 1998;41:1087-1092.

[19.] Bastacky SI, Walsh PC, Epstein JI. Relationship between perineural tumor invasion on needle biopsy and radical prostatectomy capsular penetration in clinical stage B adenocarcinoma of the prostate. Am J Surg Pathol. 1993;17:336-341.

[20.] Holmes GF, Walsh PC, Pound CR, Epstein JI. Excision of the neurovascular bundle at radical prostatectomy in cases with perineural invasion on needle biopsy. Urology. 1999;53:752-756.

[21.] Vargas SO, Jiroutek M, Welch MR, et al. Perineural invasion in prostate needle biopsy specimens: correlation with extraprostatic extension at resection. Am J Clin Pathol. 1999;111:223-228.

[22.] Egan AJM, Bostwick DG. Prediction of extraprostatic extension of prostate cancer on needle biopsy findings: perineural invasion lacks significance on multivariate analysis. Am J Surg Pathol. 1998;21:1496-1500.

[23.] National Prostate Cancer Detection Project. Workshop on Prostatic Intraepithelial Neoplasia: significance and correlation with prostatic specific antigen and transrectal ultrasound. Urology. 1989;34(6 suppl).

[24.] Bostwick DG. Prospective origins of prostate carcinoma: prostatic intraepithelial neoplasia and atypical adenomatous hyperplasia. Cancer. 1996;78:330-336.

[25.] Bostwick DG. High-grade prostatic intraepithelial neoplasia: the most likely precursor of prostatic cancer. Cancer. 1995;75:1823-1836.

[26.] Graham SD Jr, Bostwick DG, Hoisaeter A, et al. Report of the Committee on Staging and Pathology: International Workshop on Prostatic Cancer and Hyperplasia. Cancer. 1992;70 (1 suppl):359-361.

[27.] Humphrey PA, Walther PJ. Adenocarcinoma of the prostate, h simple sampling considerations. Am J Clin Pathol. 1993;99:746-759.

[28.] Grignon DJ, Sakr WA. Pathologic staging of prostate carcinoma: what are the issues? Cancer. 1996;78:337-340.

[29.] Epstein JI. The evaluation of radical prostatectomy specimens: therapeutic and prognostic implications. Pathol Annu. 1991;26:159-210.

[30.] Bostwick DG, Montironi R. Evaluating radical prostatectomy specimens: therapeutic and prognostic importance. Virchows Arch. 1997;430:1-16.

[31.] Sakr WA, Wheeler TM, Blute M, et al. Staging and reporting of prostate cancer: sampling of the radical prostatectomy specimen. Cancer. 1996;78:366-369.

[32.] Blute ML, Bostwick DG, Seay TM, et al. Pathologic classification of prostate carcinoma: impact of margin status. Cancer. 1998;82:902-908.

[33.] Epstein JI, Sauvageot J. Do close but negative margins in radical prostatectomy specimens increase the risk of postoperative progression? J Urol. 1997; 157:241-243.

[34.] Graefen M, Hammerer P, Michl U, et al. Incidence of positive surgical margins after biopsy-selected nerve-sparing radical prostatectomy. Urology. 1998; 51:437-442.

[35.] Ohori M, Wheeler T, Kattan MW, et al. Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol. 1995;154:1818-1824.

[36.] Weldon VE, Tavel FR, Neuwirth H, Cohen R. Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. J Urol. 1995;153:1565-1569.

[37.] Fleming ID, Cooper JS, Henson DE, et al, eds. AJCC Manual for Staging of Cancer. 5th ed. Philadelphia, Pa: Lippincott Raven; 1997.

[38.] Sobin LH, Wittekind C, eds. TNM Classification of Malignant Tumours. 5th ed. International Union Against Cancer. New York, NY: Wiley; 1997.

Accepted for publication February 1, 2000.

From McMaster University, Hamilton, Ontario, Canada (Dr Srigley); Emory University, Atlanta, Ga (Dr Amin); Bostwick Laboratories, Richmond, Va (Dr Bostwick); Wayne State University, Detroit, Mich (Dr Grignon); and the University of Utah School of Medicine, Salt Lake City, Utah (Dr Hammond).

Originally published in the Archives of Pathology & Laboratory Medicine, August 1994.

Reprints: Joe Schramm, College of American Pathologists, 325 Waukegan Rd, Northfield, Ill.
COPYRIGHT 2000 College of American Pathologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2000 Gale, Cengage Learning. All rights reserved.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Author:Srigley, John R.; Amin, Mahul B.; Bostwick, David G.; Grignon, David J.; Hammond, M. Elizabeth H.
Publication:Archives of Pathology & Laboratory Medicine
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Jul 1, 2000
Words:4560
Previous Article:Updated Protocol for the Examination of Specimens From Patients With Carcinomas of the Breast.
Next Article:Clinicians Are From Mars and Pathologists Are From Venus.
Topics:



Related Articles
Prognostic Factors in Prostate Cancer.
Statistical Issues in Tumor Marker Studies.
Updated Protocol for the Examination of Specimens From Patients With Carcinomas of the Colon and Rectum, Excluding Carcinoid Tumors, Lymphomas,...
Updated Protocol for the Examination of Specimens From Patients With Carcinomas of the Breast.
Recurrent Prostate Carcinoma Presenting as Omental Large Cell Carcinoma With Neuroendocrine Differentiation and Resulting in Bowel Obstruction.
Incidental Prostatic Adenocarcinomas and Putative Premalignant Lesions in TURP Specimens Collected Before and After the Introduction of...
Histologic and Histochemical Characterization of Seminal Vesicle Intraluminal Secretions.
High-Grade Prostatic Intraepithelial Neoplasia.
Morphologic criteria for the diagnosis of prostatic adenocarcinoma in needle biopsy specimens: a study of 250 consecutive cases in a routine surgical...
Distinguishing prostatic from colorectal adenocarcinoma on biopsy samples: the role of morphology and immunohistochemistry.

Terms of use | Copyright © 2014 Farlex, Inc. | Feedback | For webmasters