How much tissue sampling is required when unsuspected minimal prostate carcinoma is identified on transurethral resection?
CONTEXT: When minimal prostate cancer is detected in the initial transurethral resection of the prostate (TURP) sample, it is uncertain how extensively the remaining tissue should be sampled for accurate grading and staging. OBJECTIVE: To identify whether additional partial or complete sampling is required to accurately evaluate TURP samples with minimal cancer (stage T1a). DESIGN: We prospectively examined all TURP samples in our institution during 1 year. All specimens were sampled randomly in 6 cassettes. When minimal cancer was found, we performed additional partial sampling (1 block per 5 g of remaining tissue), followed by complete submission of all remaining tissue. All samples were evaluated separately to identify possible changes in Gleason score and tumor volume. We performed a cost analysis for the additional tissue sampling. RESULTS: Of 747 TURP samples evaluated on the initial 6 cassettes, 125 (16.7%) contained prostate cancer. Minimal cancer involving less than 5% of samp
UroToday.com – Transurethral resection of prostate (TURP) is still a common urological procedure that is primarily used in the current practice for the surgical management of benign prostatic hyperplasia. The quantity of tissue chips received in the pathology laboratory for examination varies. Recommendations by the College of American Pathologists (CAP) require submission of specimens weighing 12 grams or less in their entirety, usually in 6 to 8 cassettes. For specimens greater than 12 grams, the initial 12 grams should be submitted, and one cassette for every additional 5 g may be submitted. The CAP committee recently added a recommendation that “if an unsuspected carcinoma is found in the tissue submitted and it involves 5% or less of the tissue examined, the remaining tissue is generally submitted for microscopic examination”. Accurate patient staging is important clinically because patients with incidental tumors found on histology involving 5% or less of resected tissue (stageT1
