Worldwide, clinically detected prostate cancer is the second most common malignancy, with an estimated 1.1 million new cases in 2012. Standard active treatments for prostate cancer include radiotherapy and/or radical prostatectomy (RP) (for clinically localized prostate cancer). Also active surveillance is a management strategy to avoid or delay the potential harms caused by radical treatments. At this point, a pathology report plays a major role. Appropriate handling and systematic examination of a RP specimen is essential for the identification of tumor characteristics such as grade, volume, pathological stage, and surgical margin status. Although some minor differences in macroscobic evaluation may be seen among authors, it is essential to paint and sample the entire prostatectomy specimen. Most prostate tumors are heterogeneous and multifocal compared to tumors of other organs. This makes macroscopic assessment of prostatectomy specimen challenging and sampling of a representative material from the main tumor focus difficult. Also determining tumor burden and to interpret all surgical margins total sampling of the material is essential.
Dünyada, klinik olarak tespit edilen prostat kanseri, 2012’de tahmin edilen 1,1 milyon yeni olguyla en sık görülen ikinci malignitedir. Prostat kanseri için standart aktif tedaviler arasında radyoterapi ve/veya radikal prostatektomi (klinik olarak lokalize prostat kanseri için) bulunur. Ayrıca aktif izlem, diğer tedavilerin neden olduğu olası zararları önlemek veya geciktirmek için uygun hastalarda alternatif bir tedavi yöntemidir. Bu noktada patoloji raporu önemli rol oynar. Radikal prostatektomi materyalinin uygun makroskobik incelemesi ve örneklenmesi son derece önemlidir. Otörler arasında bazı küçük farklılıklar görünse de, prostatektomi materyalini boyamak ve total örneklemek gerekir. Ayrıca tümör yükünün belirlenmesi ve tüm cerrahi sınırların yorumlanabilmesi için totale yakın örnekleme önemlidir.
1. Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Geneva, Switzerland: WHO Press; 2016.
2. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JD, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gres, DM, Meyer LR. AJCC Cancer Staging Manual. Ed. 8 Cham, Switzerland: Springer; 2017.
3. Karabulut YY. Summary of the Changes in the 8th Edition of the TumorNode- Metastasis Staging of Urological and Male Genital Organs Cancers. Journal of Urological Surgery 2018;5(2):133-139.
4. Egevad L, Srigley JR and Delahunt B. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens: rationale and organization. Modern Pathology (2011) 24,1-5.
5. Srigley JR, Amin MB, Epstein JI, et al. Updated protocol for the examination of specimens from patients with carcinomas of the prostate gland. Arch Pathol Lab Med 2006;130:936-946.
6. Srigley JR. Key issues in handling and reporting radical prostatectomy specimens. Arch Pathol Lab. Med 2006;130:303-317.
7. Cristina Magi-Galluzzi, Andrew J Evans, Brett Delahunt, Jonathan I Epstein at al. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease. Modern Pathology (2011) 24,26-38.
8. Ekici S, Ayhan A, Erkan I, et al. The role of the pathologist in the evaluation of radical prostatectomy specimens. Scand J Urol Nephrol 2003;37:387- 391.
9. Villers A, McNeal JE, Redwine EA, et al. The role of perineural space invasion in the local spread of prostatic adenocarcinoma. J Urol 1989;142:763-768.
10. Galluzzi M, Evans AJ, Delahunt B, Epstein JI, Griffiths DF, Kwast T, Montironi R, Thomas M, Srigley J, Egevad L, Humphrey P; The ISUP Prostate Cancer Group. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease. Modern Pathology (2011) 24,26-38.
11. Epstein JI, Carmichael MJ, Pizov G, et al. Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term follow-up. J Urol 1993;150:135-141.
12. Wheeler TM, Dillioglugil O, Kattan MW, et al. Clinicaland pathological significance of the level and extent ofcapsular invasion in clinical stage T1-2 prostate cancer. Hum Pathol 1998;29:856-862.
13. Van der Kwast TH, Collette L, Van Poppel H, et al.Impact of pathology review of stage and margin status of radical prostatectomy specimens . Virchows Arch 2006;449:428-434.
14. Wieder JA, Soloway MS. Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol 1998;160:299-315.
15. Preston MA, Carrière M, Raju G, et al. The prognostic significance of capsular incision into tumor during radical prostatectomy. Eur Urol 2011;59:613-8.
16. Shuford MD, Cookson MS, Chang SS, et al. Adverse prognostic significance of capsular incision with radical retropubic prostatectomy. J Urol 2004; 172:119-23.
17. Chalfin HJ, Dinizo M, Trock BJ, et al. Impact of surgical margin status on prostate-cancer-specific mortality. BJU Int 2012; 110:1684-9.
18. Epstein JI. Incidence and significance of positive margins in radical prostatectomy specimens. Urol Clin North Am 1996; 23:651-63.
19. Park SW, Readal N, Ceong BC, at al. Risk Factors for Intraprostatic Incision into Malignant Glands at Radical Prostatectomy. Eur Urol 2015;68:311-316.
20. Freedland SJ, Grubb KA, Yiu SK, et al. Obesity and capsular incision at the time of open retropubic radical prostatectomy. J Urol 2005;174:1798-801.
21. Edge SB, Byrd DR, Carducci M, et al. AJCC Cancer Staging Manual 7th edn. Springer: New York, NY, 2009.)
22. Rodriguez-Covarrubias F, Larre S, Dahan M, et al. Invasion of bladder neck after radical prostatectomy: one definition for different outcomes. Prostate Cancer Prostatic Dis 2008;11:294-297.
23. Buschemeyer 3rd WC, Hamilton RJ, Aronson WJ, et al. Is a positive bladder neck margin truly a T4 lesion in the prostate specific antigen era? Results from the SEARCH Database. J Urol 2008;179:124-129.
24. Dash A, Sanda MG, Yu M, et al. Prostate cancer involving the bladder neck: recurrence-free survival and implications for AJCC staging modification. American Joint Committee on Cancer. Urology 2002; 60:276-280.