RPeval

"The Pathology Report Following Prostatectomy"

By Jonathan Oppenheimer, M.D.
prostatelab@gmail.com

One of the most important pieces of information to be obtained from the post-operative pathology report is the assessment of surgical margins and capsular penetration. Organ confined tumor means the tumor is within the confines of the anatomical
prostate (i.e., within the outer shell of the "walnut"). Established capsular penetration means that more than a few glands are
found outside the normal confines of the prostate When the surgeon removes the prostate, he often includes a thin rim of
non-prostatic soft tissue that surrounds the prostate. The outer aspect of this soft tissue constitutes the surgical margin.

One may take such information as presence of capsular penetration and the status of surgical margins and combine it with
Gleason grade, DNA ploidy, microvascular density (BioStage™), and PSA to arrive at a probability that the cancer was not completely removed by surgery. Such a determination may suggest the early use of additional salvage treatments such as radiation and/or hormonal therapy.

If hormonal therapy has preceded the surgery (neoadjuvant therapy) careful examination of the removed tissue will tell if the
anti-androgen therapy was successful in stopping the growth of the cancer, or whether hormone insensitive cancer cells have
continued to proliferate. Gleason grading should not be attempted on such hormonally treated tissue as the resulting changes
will cause an artificial increase in perceived grade as a direct result of the therapy.

Other items of note that may appear on the post-surgical pathology report include seminal vesicle involvement, intravascular
involvement, involvement of nerve twigs at the periphery of the gland, size of tumor nodule(s) with calculation of volumes,
presence of intraductal features, and the percentage of poorly differentiated tumor (Gleason pattern 4 and above) within the
tumor.

Recuts are additional slides prepared from tissue remaining in the paraffin blocks. Recuts are made either because a pathologist needs to see more tissue "deeper in the block" to confirm or rule-out a malignant diagnosis, or because slides are to be sent to a different pathologist for a second opinion (i.e., an outside consultation). New tissue sections are cut, placed on glass slides and stained. This entails extra expense to the lab, but they will often absorb this cost rather than parting with their original slides.

In summary, taking the time to understand your pathology and laboratory reports will help you become a more active and
informed participant in the medical decisions that will affect your future.