Updated protocol for the examination of specimens from patients with carcinomas of the prostate gland.

Department of Laboratory Medicine, Credit Valley Hospital, Mississauga, Ontario, Canada.
Archives of pathology & laboratory medicine (Impact Factor: 2.88). 08/2006; 130(7):936-46. DOI: 10.1043/1543-2165(2006)130[936:UPFTEO]2.0.CO;2
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    ABSTRACT: Objectives. To identify rates of incidentally detected prostate cancer in patients undergoing surgical management of benign prostatic hyperplasia (BPH). Materials and Methods. A retrospective review was performed on all transurethral resections of the prostate (TURP) regardless of technique from 2006 to 2011 at a single tertiary care institution. 793 men (ages 45-90) were identified by pathology specimen. Those with a known diagnosis of prostate cancer prior to TURP were excluded (n = 22) from the analysis. Results. 760 patients had benign pathology; eleven (1.4%) patients were found to have prostate cancer. Grade of disease ranged from Gleason 3 + 3 = 6 to Gleason 3 + 4 = 7. Nine patients had cT1a disease and two had cT1b disease. Seven patients were managed by active surveillance with no further events, one patient underwent radiation, and three patients underwent radical prostatectomy. Conclusions. Our series demonstrates that 1.4% of patients were found to have prostate cancer, of these 0.5% required treatment. Given the low incidental prostate cancer detection rate, the value of pathologic review of TURP specimens may be limited depending on the patient population.
    The Journal of Urology 01/2014; 2014:627290. DOI:10.1155/2014/627290 · 3.75 Impact Factor
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    ABSTRACT: BACKGROUND: Significant cancer in contralateral sides of the prostate that was missed on prostate biopsy (PBx) is a concern in hemiablative focal therapy (FT) of prostate cancer (PCa). However, extended PBx, a common diagnostic procedure, has a limited predictive ability for lobes without significant cancer. OBJECTIVE: To identify prostate lobes without significant cancer using extended PBx combined with diffusion-weighted imaging (DWI), which has the potential to provide pathophysiologic information on pretreatment assessment. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prebiopsy DWI study between 2007 and 2012 that included 270 prostate lobes in 135 patients who underwent radical prostatectomy (RP) for clinically localized PCa. INTERVENTION: Participants underwent DWI and 14-core PBx; those with PBx-proven PCa and who were treated with RP were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Imaging and pathology were assessed in each side. Based on RP pathology, lobes were classified into lobes with no cancer (LNC), lobes with indolent cancer (LIC), and lobes with significant cancer (LSC). Predictive performance of DWI, PBx, and their combination in identifying lobes without significant cancer was examined. RESULTS AND LIMITATIONS: LNC, LIC, and LSC were identified in 23 (8.5%), 64 (23.7%), and 183 sides (67.8%), respectively. The negative predictive values (NPV) of DWI, PBx, and their combination were 22.1%, 27.8%, and 43.5%, respectively, for lobes with any cancer (ie, either LIC or LSC), and 68.4%, 72.2%, and 95.7%, respectively, for LSC. The NPV of PBx for LSC was improved by the addition of DWI findings (p=0.001), with no adverse influence on the positive predictive value. Limitations included a possible selection bias under which the decision to perform PBx might be affected by DWI findings. CONCLUSIONS: The combination of DWI and extended PBx efficiently predicts lobes without significant cancer. This procedure is applicable to patient selection for hemiablative FT.
    European Urology 10/2012; 65(1). DOI:10.1016/j.eururo.2012.10.010 · 10.48 Impact Factor
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    ABSTRACT: This study reports a modified point-count method for quantifying the extent of carcinoma in prostatectomy specimens (n = 143), as adapted from Billis et al., Int Braz J Urol. 2003.29:113-120. The prostates were studied as follows: The basal/apical margins were sampled using the cone method. The remainder of the gland was divided into 12 quadrant-shaped regions that were sampled using two slices. Eight equidistant points were marked directly on the coverslip over each fragment. The points inside the tumoral areas were counted and expressed as both the percentage of prostate gland involvement by carcinoma (PGI) and the tumor volume (TV). A significant correlation between the preoperative PSA levels and each of the three quantitative estimations were observed, with improved correlations with the PGI and TV values obtained using the point-count method (viz. number of slices involved (NSI) (r = 0.32), PGI (r = 0.39) and TV (r = 0.44). With the data sets stratified into three categories, all three methods correlated with multiple parameters, including Gleason scores ≥7, primary Gleason scores ≥4, perineural/angiolymphatic invasion, extraprostatic extension, seminal vesicle invasion and positive margins. All three quantitative methods were associated with morphologic features of tumor progression. The results obtained using this modified point-count method correlate more strongly with preoperative PSA levels.
    Pathology - Research and Practice 05/2014; DOI:10.1016/j.prp.2014.02.002 · 1.56 Impact Factor