Prostate

Background

Radical prostatectomy is usually undertaken for treatment of malignancy after diagnosis by transrectal ultrasound guided (TRUS) biopsy or transurethral resection of prostate (TURP). 

This protocol is relevant to prostatectomy specimens.

See also Gentiourinary small biopsy instructions for other prostate specimens.


Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Fresh tissue received

  • No
    • Non-normal fixation (not formalin), describe
  • Yes
    • Special studies required, describe
    • Ensure samples are taken prior to fixation.

Intraoperative consultation

  • Not performed
  • Performed, describe type and result
    • Frozen section
    • Imprints
    • Other, specify

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate and identify anatomical features of the specimen; prostate, seminal vesicles, urethra and vasa deferentia.

Record additional orientation or designation provided by operating clinician:

  • Absent
  • Present
    • Method of designation (e.g. suture, incision)
    • Feature denoted
More detail
Orientation can be difficult and misleading features can be present due to incisions during surgery. For example: 1,2
  • Disruption of surface connective tissue (fascia), causing retraction and exposure of underlying tissues, can give the false impression of a positive margin
  • Loss of normal shape of the gland with gross distortion of hyperplastic tissue protruding through incisions
  • Detachment of seminal vesicles

It is recommended to inspect the prostate while fresh if possible.

Orientation tips 1,2

  • Denonvillier’s fascia is located posteriorly and has a smooth, glistening surface.
  • The posterior aspect of the prostate has a mid-line groove, is less convex and is longer than the anterior surface.
  • Seminal vesicles (if attached) connect to the prostate on the posterior aspect of the base.
  • The apex of the prostate is more tapered than the base (at the bladder neck).
  • Cut surface of prostate tissue is duller and has more irregular appearance than overlying fascia.

Remove all surgical clips and sutures prior to fixation if possible.

Describe the following features of the specimen:

Procedure

​Record as stated by the clinician.
  • Radical prostatectomy (for tumour)
  • Transrectal ultrasound guided biopsy (TRUS) see small biopsy instructions
  • Suprapubic prostatectomy for nodular hyperplasia
  • Retropubic enucleation prostatectomy
  • Other, describe

Specimen integrity

  • Intact
  • Disrupted
  • Morcellated

Anatomical components included (more than one may apply) and dimensions (mm)

Describe and measure the anatomical components present.

Prostate, intact
  • Three dimensions; apex to base, right to left, anterior to posterior
Prostate, morcellated
  • Aggregate measurement of tissues pieces in three dimensions
Seminal vesicles
  • Absent
  • Present
    • Left, maximum dimension
    • Right, maximum dimension
Vasa deferens (if present)
  • Absent
  • Present
    • Left, length x diameter
    • Right, length x diameter
Weight (g)
  • Prostate without seminal vesicles

DissectionBack to top


Radical prostatectomy 1,3-5

Paint the relevant surgical margins with ink and record the colours applied. At least two colours to denote right and left sides should be used. Four different colours are commonly used to designate left lateral, right lateral, anterior and posterior surfaces.

Truncate the seminal vesicles at the base of each. Transversely section a 5-10mm segment from the apical margin and serially section the body of the gland from apex to base perpendicularly to the urethra at 3-4mm intervals. 

Serially section the slices from the apex and base perpendicular to the cut surface allowing assessment of their margins.

Two methods are suggested for dissection of the seminal vesicles; either transverse or longitudinal sections that demonstrate the junction of the vesicle with the prostate.

Lay out the sections sequentially as indicated in the diagram provided.

Photograph the dissected specimen and use to record the blocks selected for processing.

Suprapubic/retropubic prostatectomy for nodular hyperplasia

Where apex and base can be identified, section the body of the prostate in a similar way to the prostatectomy for tumour.

Internal InspectionBack to top


Describe the following items: 

Radical prostatectomy

Lymph nodes

Retrieved from resection specimen

  • Describe site(s) and laterality
  • Number retrieved

Separately submitted

  • For each container, record specimen number and designation
  • Collective size of tissue in three dimensions (mm)
  • Number of grossly identified lymph nodes submitted
  • Maximum diameter of each (mm)

Suprapubic/retropubic prostatectomy for nodular hyperplasia

Carefully identify and describe any suspicious areas (firm, yellow, peripherally-situated nodules).

ProcessingBack to top


Dissect the specimen further and submit sections for processing according to the diagram provided.

Radical prostatectomy 1,3-5

Submit serial sections of entire prostate if possible.

If only partial submission is possible, submit all sections from:

  • Apical margin
  • Bladder neck margin (base of prostate)
  • Seminal vesicles, demonstrating junction with prostate
  • Lymph nodes
Submit representative sections of the tumour including:
  • Areas of tumour close to margin
  • Areas of possible extraprostatic extension (usually posterolateral aspects)

Suprapubic/retropubic prostatectomy for nodular hyperplasia 1,6-9

Submit at least eight representative sections including from:

  • Each lobe (if known)
  • Any suspicious areas (see above)
  • Perpendicular sections of urethra and/or base

Record details of each cassette.

An illustrated block key similar to the one provided may be useful.

Block allocation key

Cassette id
Site
No. of pieces
A-B
Apex, perpendicular sections
 
C-R
Prostate body, as per block key
 
S-T
Base, perpendicular sections
 
U-V
Left seminal vesicle and vas (if applicable)
 
W-X
Right seminal vesicle and vas (if applicable)
 
Y
Fat pad
 

Acknowledgements

A/Prof Hemamali Samaratunga for her contribution in reviewing and editing this protocol.

ReferencesBack to top


  1. Harnden P, Berney D and Shelley M. Dataset for histopathology reports for prostatic carcinoma, The Royal College of Pathologists, London, 2009.
  2. Barré C. Open radical retropubic prostatectomy. Eur Urol 2007;52(1):71-80.
  3. Kench J, Clouston D, Delahunt B, Delprado W, Eade T, Ellis D, Horvath L, Kneebone A, Samaratunga H, Stahl J and Stapleton A. Prostate cancer (radical prostatectomy) structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2014.
  4. Grossfeld GD, Chang JJ, Broering JM, Miller DP, Yu J, Flanders SC and Carroll PR. Does the completeness of prostate sampling predict outcome for patients undergoing radical prostatectomy?: data from the CAPSURE database. Urology 2000;56(3):430-435.
  5. Srigley JR (2006). Key issues in handling and reporting radical prostatectomy specimens. Arch Pathol Lab Med 2006;130(3):303-317.
  6. College of American Pathologists. Cancer Protocols, 2009.
  7. Humphrey PA and Walther PJ (1993). Adenocarcinoma of the prostate. I. Tissue sampling considerations. Am J Clin Pathol 99(6):746-759.
  8.  Sehdev AE, Pan CC and Epstein JI (2001). Comparative analysis of sampling methods for grossing radical prostatectomy specimens performed for nonpalpable (stage T1c) prostatic adenocarcinoma. Hum Pathol 32(5):494-499.
  9. O’Rourke D, Turner G and Allen D (2010). Tissue Pathways for Urological Pathology, The Royal College of Pathologists, London.