Articles

A Contemporary Update on Pathology Reporting for Prostate Cancer: Biopsy and Radical Prostatectomy Specimens

By: Samson W. Finea lowast , Mahul B. Aminb, Daniel M. Berneyc, Anders Bjartelld, Lars Egevade, Jonathan I. Epsteinf, Peter A. Humphreyg, Christina Magi-Galluzzih, Rodolfo Montironii and Christian Stiefj

Published online: 01 July 2012

Keywords: Gleason grading, Needle biopsy, Prostate cancer, Radical prostatectomy, Reporting, Staging

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Abstract

Context

The diagnosis of and reporting parameters for prostate cancer (PCa) have evolved over time, yet they remain key components in predicting clinical outcomes.

Objective

Update pathology reporting standards for PCa.

Evidence acquisition

A thorough literature review was performed for articles discussing PCa handling, grading, staging, and reporting published as of September 15, 2011. Electronic articles published ahead of print were also considered. Proceedings of recent international conferences addressing these areas were extensively reviewed.

Evidence synthesis

Two main areas of reporting were examined: (1) prostatic needle biopsy, including handling, contemporary Gleason grading, extent of involvement, and high-risk lesions/precursors and (2) radical prostatectomy (RP), including sectioning, multifocality, Gleason grading, staging of organ-confined and extraprostatic disease, lymph node involvement, tumor volume, and lymphovascular invasion. For each category, consensus views, controversial areas, and clinical import were reviewed.

Conclusions

Modern prostate needle biopsy and RP reports are extremely detailed so as to maximize clinical utility. Accurate diagnosis of cancer-specific features requires up-to-date knowledge of grading, quantitation, and staging criteria. While some areas remain controversial, efforts to codify existing knowledge have had a significant impact on pathology practice.

Take Home Message

Modern prostate needle biopsy and radical prostatectomy reports are extremely detailed so as to maximize clinical utility. Accurate diagnosis of cancer-specific features requires up-to-date knowledge of grading, quantitation, and staging criteria. While some areas remain controversial, efforts to codify existing knowledge have significantly affected pathology practice.

Keywords: Gleason grading, Needle biopsy, Prostate cancer, Radical prostatectomy, Reporting, Staging.

Footnotes

a Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

b Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

c Department of Molecular Oncology and Imaging, St. Bartholomew's Hospital Queen Mary University of London, London, UK

d Department of Urology, Skåne University Hospital, Malmö, Sweden

e Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden

f Departments of Oncology, Pathology and Urology, Johns Hopkins Hospital, Baltimore, MD, USA

g Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA

h Department of Anatomic Pathology, Cleveland Clinic and Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

i Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy

j Department of Urology, Ludwig Maximilians-Universität München, Munich, Germany

lowast Corresponding author. Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue—Room C513, New York, NY 10065, USA. Tel. +1 212 639 5066; Fax: +1 646 422 2070.