Virchows Archiv

, Volume 430, Issue 1, pp 1–16 | Cite as

Evaluating radical prostatectomy specimens: Therapeutic and prognostic importance

Review Article


The pathologic staging of prostate cancer involves determination of the anatomic extent and burden of tumor based on the best available data. Proper examination of radical prostatectomy specimens is critical in determining cancer stage, stratifying patient need for adjuvant treatment, and prediction of patient outcome. Differences exist in methods of handling and sampling specimens, although publication of practice protocols in recent years has led to convergence of opinion. In this report, we evaluate the current aspects of pathologic staging of prostate cancer and assessment of prostatectomy specimens. Recent international agreement on pathologic staging of prostate cancer should allow valid comparisons of surgical treatment from different institutions. The vanishing cancer phenomenon is also briefly discussed.

Key words

Prostate Prostatic neoplasms Staging Surgery Pathology Radical Prostatectomy Prognosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ackerman DA, Barry JM, Wicklund RA, Olson N, Lowe BA (1993) Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy. J Urol 150:1845–1850Google Scholar
  2. 2.
    Adolfsson J (1993) Deferred treatment of low grade stage T3 prostate cancer without distant metastases. J Urol 149:326–329Google Scholar
  3. 3.
    Armas OA, Aprikian AG, Melamed J, Cordon-Cardo C, Cohen DW, Erlandson R, Fair WR, and Reuter VE (1994) Clinical and pathological effects of neoadjuvant total androgen ablation therapy on clinically localized prostatic adenocarcinoma. Am J Surg Pathol 18:979–991Google Scholar
  4. 4.
    Association of Directors of Anatomic and Surgical Pathology (1996) Recommendations for the reporting of resected prostate carcinomas. Hum Pathol 27:321–323Google Scholar
  5. 5.
    Ayala AG, Ro JY, Babaian R, Troncoso P, and Grignon DJ (1989) The prostatic capsule: does it exist? Its importance in the staging and treatment of prostatic carcinoma. Am J Surg Pathol 13:21–27Google Scholar
  6. 6.
    Bagshaw MA, Cox RS, Ray GR (1988) Status of radiation treatment of prostate cancer at Stanford University. Natl Cancer Inst Monogr 7:47–60Google Scholar
  7. 7.
    Bahnson RR, Dresner SM, Gooding W, Becich MJ (1989) Incidence and prognostic significance of lymphatic and vascular invasion in radical prostatectomy specimens. Prostate 15:149–155Google Scholar
  8. 8.
    Bastacky SI, Walsh PC, Epstein JI (1993) Relationship between perineural tumor invasion on needle biopsy and radical prostatectomy capsular penetration in clinical stage B adenocarcinoma of the prostate. Am J Surg Pathol 17:336–341Google Scholar
  9. 9.
    Blackwell KL, Bostwick DG, Zincke H, et al (1994) Combining prostate specific antigen with cancer and gland volume to predict more reliably pathologic stage: the influence of prostate specific antigen cancer density. J Urol 151:1565–1570Google Scholar
  10. 10.
    Bostwick DG (1994) The significance of tumor volume in prostate cancer. Urol Ann 8:1–22Google Scholar
  11. 11.
    Bostwick DG, Cooner WH, Denis L, et al (1992) The association of benign prostatic hyperplasia and cancer of the prostate. Cancer 70:291–301Google Scholar
  12. 12.
    Bostwick DG, Graham SD Jr, Napalkov P, Abrahamsson P-A, Sant'Agnese PA di, Algaba F, Hoisaeter PA, Lee F, Littrup P, Mostofi FK, Denis L, Schroeder F, Murphy GP (1993) Staging of early prostate cancer: a proposed tumor volume-based prognostic index. Urology 41:403–411Google Scholar
  13. 13.
    Bostwick DG, Myers RP, Oesterling JE (1994) Staging of prostate cancer. Semin Surg Oncol 10:60–73Google Scholar
  14. 14.
    Bova GS, Fox WM, Epstein JI (1993) Methods of radical prostatectomy specimen processing: a novel technique for harvesting fresh prostate cancer tissue and review of processing techniques. Mod Pathol 6:201–207Google Scholar
  15. 15.
    Brawer MK, Chemer MP, Beatie J, et al (1992) Screening for prostatic carcinoma with prostate-specific antigen. J Urol 147:841–844Google Scholar
  16. 16.
    British Association of Urological Surgeons TNM Subcommittee (1995) The TNM classification of prostate cancer: a discussion of the 1992 classification. Br J Urol 76:279–285Google Scholar
  17. 17.
    Byar DP, Mostofi FK (1972) Carcinoma of the prostate: prognostic evaluation of certain pathologic features in 208 radical prostatectomies. Cancer 30:5–13Google Scholar
  18. 18.
    Catalona WJ, Dresner SM (1985) Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function. J Urol 134:1149–1151Google Scholar
  19. 19.
    Catalona WJ, Smith DS, Ratliff TL, et al (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324:1156–1161Google Scholar
  20. 20.
    Civantos F, Marcial MA, Banks ER, Ho CK, Speights VD, Drew PA, Murphy WM, Soloway MS (1995) Pathology of androgen deprivation therapy in prostate carcinoma. A comparative study of 173 patients. Cancer 75:1634–1641Google Scholar
  21. 21.
    Cohen MB, Soloway Ms, Murphy WM (1994) Sampling of radical prostatectomy specimens. How much is adequate? Am J Clin Pathol 101:250–252Google Scholar
  22. 22.
    Cooner WH, Mosley BR, Rutherford CL Jr, et al (1990) Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate-specific antigen. J Urol 143:1146–1151Google Scholar
  23. 23.
    Corn BW, Hanks GE, Lee WR, Schultheiss T (1995) Do the current subclassifications of stage T3 adenocarcinoma of the prostate have clinical relevance? Urology 45:484–490Google Scholar
  24. 24.
    Donahue RE, Miller GJ (1991) Adenocarcinoma of the prostate: biopsy to whole mount. Denver VA experience. Urol Clin North Am 18:449–452Google Scholar
  25. 25.
    Donaldson ES, Glenn JF (1996) The 1995 staging requirement for approved cancer programs. Urology 47:455–456Google Scholar
  26. 26.
    Ellison E, Chuang S-S, Zincke H, Ferguson J, Bostwick DG (1996) Prostate adenocarcinoma following androgen deprivation therapy. A comparative study of morphology, morphometry, immunohistochemistry, and DNA ploidy. Pathol Case Rev 1:74–83Google Scholar
  27. 27.
    Epstein JI (1994) Pathology of prostatic intraepithelial neoplasia and adenocarcinoma of the prostate: prognostic influences of stage, tumor volume, grade, and margins of resection. Semin Oncol 21:527–541Google Scholar
  28. 28.
    Epstein JI, Carmichael M, Partin AW, Walsh PC (1993) Is tumor volume an independent predictor of progression following radical prostatectomy? A multivariate analysis of 185 clinical stage B adenocarcinoma of the protate with 5 years of follow-up. J Urol 149:1478–1485Google Scholar
  29. 29.
    Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage Tlc) prostate cancer. JAMA 271:368–374Google Scholar
  30. 30.
    Epstein JI, Partin AW, Suavageot J, Walsh PC (1996) Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. Am J Surg Pathol 20:286–292Google Scholar
  31. 31.
    Ferguson J, Bostwick DG, Ellison E, Zincke H (1994) Decrease of prostatic intraepithelial neoplasia (PIN) following androgen deprivation therapy in patients with stage T3 prostatic adenocarcinoma. Urology 44:91–95Google Scholar
  32. 32.
    Ferguson JK, Bostwick DG, Suman V, Zincke H, Oesterling JE (1995) Prostate-specific antigen detected prostate cancer. Pathological characteristics of ultrasound visible versus ultrasound invisible tumors. Eur Urol 27:8–12Google Scholar
  33. 33.
    Friedman GD, Hiatt RA, Quesenberry CP, Selby JV (1991) Case-control study of screening for prostate cancer by digital rectal examinations. Lancet 337:1526–1529Google Scholar
  34. 34.
    Goldstein NS, Begin LR, Grody WW, Novak JM, Qian J, Bostwick DG (1995) Minimal or no cancer in radical prostatetomy specimens. Report of 13 cases of the “vanishing cancer phenomenon”. Am J Surg Pathol 19:1002–1009Google Scholar
  35. 35.
    Gomella LG, White JL, McCue PA, Byrne DS, Mulholland SG (1993) Screening for occult nodal metastases in localized carcinoma of the prostate. J Urol 149:776–778Google Scholar
  36. 36.
    Graham Jr SD, Bostwick DG, Hoisaeter A, et al (1992) Report of the committee on staging and pathology. Cancer 70 [Suppl]:359–361Google Scholar
  37. 37.
    Haggman M, Norberg M, Torre M de la, Fritiofsson A, Busch C (1993) Characterization of localized prostatic cancer: distribution, grading and pT-staging in radical prostatectomy specimens. Scand J Urol Nephrol 27:7–13Google Scholar
  38. 38.
    Hall GS, Kramer CE, Epstein JI (1992) Evaluation of radical prostatectomy specimens: a comparative analysis of sampling methods. Am J Surg Pathol 16:315–324Google Scholar
  39. 39.
    Hamdy FC, Lawry J, Anderson JB, Parsons MA, Rees RC, Williams JL (1992) Circulating prostate specific antigen-positive cells correlate with metastatic prostate cancer. Br J Urol 69:392–396Google Scholar
  40. 40.
    Hasson MO, Maksem J (1980) The prostatic perineural space and its relation to tumor spread. An ultrastructural study. Am J Surg Pathol 4:143–148Google Scholar
  41. 41.
    Henson DE, Hutter RVP, Farrow GM (1994) Practice protocol for the examination of specimens removed from patients with carcinoma of the prostate gland. A publication of the Cancer Committee, College of American Pathologists. Arch Pathol Lab Med 118:779–783Google Scholar
  42. 42.
    Humphrey PA (1993) Complete histologic serial sectioning of a prostate gland with adenocarcinoma. Am J Surg Pathol 17:468–472Google Scholar
  43. 43.
    Humphrey PA, Vollmer RT (1990) Intraglandular tumor extent and prognosis in prostatic carcinoma: application of a grid method to prostatectomy specimens. Hum Pathol 21:799–804Google Scholar
  44. 44.
    Jones EC (1990) Resection margin status in radical retropubic prostatectomy specimens: relationship to type of operation, tumor size, tumor grade, and local extension. J Urol 144:89–93Google Scholar
  45. 45.
    Labrie F, Dupont A, Suburu R, et al (1992) Serum prostatespecific antigen as pre-sceening test for prostate cancer. J Urol 147:846–850Google Scholar
  46. 46.
    Lerner SE, Blute ML, Zincke H (1996) Primary surgery for clinical stage T3 adenocarcinoma of the prostate. In: Vogelzang NJ, Scardino PT, Shipley WU, Coffey DS (eds) Comprehensive textbook of genitourinary oncology. Williams and Wilkins, Baltimore, pp 803–811Google Scholar
  47. 47.
    Littrup PJ, William CR, Egglin TK, Kane RA (1991) Determination of prostate volume with transrectal US for cancer screening. II. Accuracy of in vitro and in vivo techniques. Radiology 179:49–53Google Scholar
  48. 48.
    McIntire TL, Franzina DA (1986) The presence of benign prostate glands in perineural spaces. J Urol 135:507–509Google Scholar
  49. 49.
    McNeal JE, Bostwick DG, Kindrachuk RA, Redwine EA, Freiha F, Stamey TA (1986) Patterns of progression in prostate cancer. Lancet 1:60–63Google Scholar
  50. 50.
    McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA (1990) Capsular penetration in prostate cancer: significance for natural history and treatment. Am J Surg Pathol 14:240–247Google Scholar
  51. 51.
    Mettlin C, Lee F, Drago J, Murphy GP, Investigators of American Cancer Society National Prostate Cancer Detection Project (1991) Findings on the detection of early prostate cancer in 2425 men. Cancer 67:2949–2957Google Scholar
  52. 52.
    Montie JE (1990) Significance and treatment of positive margins or seminal vesicle invasion after radical prostatectomy. Urol Clin North Am 17:803–811Google Scholar
  53. 53.
    Montie JE (1995) Staging of prostate cancer. Current TNM classification and future prospects for prognostic factors. Cancer 75:1814–1818Google Scholar
  54. 54.
    Montironi R, Muzzonigro G, Galluzzi CM, Giannulis I, Diamanti L, Polito M (1994) Effect of LHRH agonist and flutamide (combination endocrine therapy) on the frequency and location of proliferating cell nuclear antigen and apoptotic bodies in prostatic hyperplasia. J Urol Pathol 2:161–172Google Scholar
  55. 55.
    Moreno JG, Croce CM, Fischer R, Monne M, Vihko P, Mulholland SG, and Gomella LG (1992) Detection of hematogenous micrometastasis in patients with prostate cancer. Cancer Res 52:6110–6112Google Scholar
  56. 56.
    Moul JW, Kahn DG, Lewis DJ, Ho CK, Ross AA, McLeod DG (1994) Immunohistologic detection of prostate cancer pelvic lymph node micrometastases: correlation to preoperative serum prostate-specific antigen. Urology 43:68–73Google Scholar
  57. 57.
    Murphy WM, Soloway MS, Barrows GH (1991) Pathologic changes associated with androgen, deprivation therapy for prostate cancer. Cancer 68:821–828Google Scholar
  58. 58.
    Oesterling JE, Suman VJ, Zincke H, Bostwick DG (1993) PSA-detected (Clinical stage T1c or BO) prostate cancer: pathologically significant tumors. Urol Clin North Am 20: 687–693Google Scholar
  59. 59.
    Ohori M, Scardino PT, Lapin SL, Seale-Hawkins C, Link J, Wheeler TM (1993) The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer. Am J Surg Pathol 17:1252–1259Google Scholar
  60. 60.
    Ohori M, Wheeler TM, Kattan MW, Goto Y, Scardino PT (1995) Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 154:1818–1824Google Scholar
  61. 61.
    Parker SL, Tong T, Bolden S, Wingo PA (1996) Cancer statistics, 1996. CA Cancer J Clin 65:5–27Google Scholar
  62. 62.
    Partin AW, Carter HB, Chan DW, Epstein JI, Oesterling JE, Rock RC, Weber JP, Walsh PC (1990) Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume, and benign hyperplasia. J Urol 143:747–752Google Scholar
  63. 63.
    Paulson DF, Moul JW, Walther PJ (1990) Radical prostatectomy for clinical stage T1-2N0M0 prostaticc adenocarcinoma long-term results. J Urol 144:1180–1185Google Scholar
  64. 64.
    Ramchandani P, Schnall MD (1993) Magnetic resonance imaging of the prostate. Semin Roentgenol 28:74–82Google Scholar
  65. 65.
    Ravery V, Delmas V, Boccon-Gibod LA, Meulemans A, Dauge-Geffroy MC, Toublanc M, Billebaud T, Boccon-Gibod L (1994) Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistent/recurrent detectable PSA after radical prostatectomy. Urology 44:371–377Google Scholar
  66. 66.
    Ravery V, de la Taille A, Toublanc M, Boccon-Gibod L, Hermien JF, Delmas V, Boccon-Gibod L (1996) Prostate specimen reevaluation in patients with organ confined prostate cancer and postoperative biological recurrence. J Urol 155:1981–1982Google Scholar
  67. 67.
    Renshaw AA, Chang H, Amico AVD (1996) An abbreviated protocol for processing radical prostatectomy specimens: analysis of tumor grade, stage, margin status, and volume. J Urol Pathol (in press)Google Scholar
  68. 68.
    Rifkin MD, Zerhouni EA, Garsonis CA, et al. (1990) Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer: results of a multi-institutional cooperative trial. N Engl J Med 323:621–627Google Scholar
  69. 69.
    Sakr WA, Grignon DJ, Visscher DW, Wolman SR, Crissman JD (1995) Evaluating the radical prostatectomy specimen. A protocol for establishing prognostic parameters and harvesting fresh tissue samples. J Urol Pathol 3:355–364Google Scholar
  70. 70.
    Sakr W, Wheeler T, Blute M, Bodo M, Calle-Rodrigue R, Henson D, Mostofi FK, Seiffert J, Wojno K, Zincke H (1996) Staging and reporting of prostate cancer. Sampling of the radical prostatectomy specimen. Cancer 78:366–368Google Scholar
  71. 71.
    Salamao DR, Graham SD, Bostwick DG (1995) Microvascular invasion in prostate cancer correlates with pathologic stage. Arch Pathol Lab Med 119:1050–1054Google Scholar
  72. 72.
    Sattar AA, Noel J-C, Vanderhaeghen J-J, Schulman CC, Wespes E (1995) Prostate capsule: computerized morphometric analysis of its components. Urology 46:178–181Google Scholar
  73. 73.
    Scaletscky R, Koch MO, Eckstein CW et al (1994) Tumor volume and stage in carcinoma of the prostate detected by elevations in prostate specific antigen. J Urol 152:129–131Google Scholar
  74. 74.
    Scardino PT (1989) Is radiotherapy effective for locally advanced (stage C or T3) prostate cancer? Prog Clin Biol Res 303:223–239Google Scholar
  75. 75.
    Scardino PT, Frankel JM, Wheeler TM, et al (1986) The prognostic significance of post-irradiation biopsy results in patients with prostatic cancer. J Urol 135:510–516Google Scholar
  76. 76.
    Schellhammer PF (1988) Radical prostatectomy. Patterns of local failure and survival in 67 patients. Urology 31:191–197Google Scholar
  77. 77.
    Schmid H-P, McNeal JE (1992) An abbreviated standard procedure for accurate tumor volume estimation in prostate cancer. Am J Surg Pathol 16:184–191Google Scholar
  78. 78.
    Schmid H-P, Ravery V, Billebaud T, Toublanc M, Boccon-Gibod LA, Hermieu JF, Delmas V, Boccon-Gibod L (1996) Early detection of prostate cancer in men with prostatism and intermediate prostate-specific antigen levels. Urology 47:699–703Google Scholar
  79. 79.
    Shroder FH, Hermanek P, Denis L, et al (1992) The TNM classification of prostate carcinoma. Prostate 4 [Suppl]:129–138Google Scholar
  80. 80.
    Smith, DM and Murphy WM (1994) Histologic changes in prostate carcinomas treated with Leuprolide (luteinizing hormone-releasing hormone effect). Distinction from poor tumor differentiation. Cancer 73:1472–1477Google Scholar
  81. 81.
    Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine EA (1987) Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med 317:909–916Google Scholar
  82. 82.
    Stamey TA, Villers AA, McNeal JE, Link PC, Freiha FS (1990) Positive surgical margins at radical prostatectomy: importance of the apical dissection. J Urol 143:1166–1173Google Scholar
  83. 83.
    Stein A, deKernion JB, Smith RB, Dorey F, Patel H (1992) Prostate specific antigen levels after radical prostatectomy in patients with organ confined and locally extensive prostate cancer. J Urol 147:942–947Google Scholar
  84. 84.
    Tent B, Srigley JR, Boivin JC, Dupont A, Monfette G, Pinault S, Labrie F (1991) Effect of combination endocrine therapy (LHRH agonist and flutamide) on normal prostate and prostatic adenocarcinoma. Am J Surg Pathol 15:111–120Google Scholar
  85. 85.
    Theiss M, Wirth MP, Manseck A, Frohmuller HGW (1995) Prognostic signficance of capsular invasion and capsular penetration in patients with clinically localized prostate cancer undergoing radical prostatectomy. Prostate 27:13–17Google Scholar
  86. 86.
    True LD (1994) Surgical pathology examination of the prostate gland. Practice survey by American Society of Clinical Pathologists. Am J Clin Pathol 10:572–579Google Scholar
  87. 87.
    Voges G, McNeal JE, Redwine EA, Freiha FS, Stamey TA (1992) Morphologic analysis of surgical margins with positive findings in prostatectomy for adenocarcinoma of the prostate. Cancer 69:520–526Google Scholar
  88. 88.
    Weldon VE, Tavel FR, Neuwirth H, Cohen R (1995) Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. J Urol 153:1565–1569Google Scholar
  89. 89.
    Wheeler TM (1989) Anatomic considerations in carcinoma of the prostate. Urol Clin North Am 16:623–634Google Scholar
  90. 90.
    Wheeler TM, Lebovitz RM (1994) Fresh tissue harvest for research from prostatectomy specimens. Prostate 25:274–279Google Scholar
  91. 91.
    Zagars GK, Geara FB, Pollack A, Eschenbach AC von (1994) The T classification of clinically localized prostate cancer. An appraisal based on disease outcome after radiation therapy. Cancer 73:1904–1912Google Scholar
  92. 92.
    Zeitman AL, Edelstein RA, Coen JJ, Babayan RK, Krane RJ (1994) Radical prostatectomy for adenocarcinoma of the prostate: the influence of preoperative and pathologic findings on biochemical disease-free outcome. Urology 43:828–833Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  1. 1.Department of PathologyMayo ClinicRochesterUSA
  2. 2.Department of PathologyUniversity of AnconaAnconaItaly

Personalised recommendations