Macroscopic Features of Prostate Cancer.
Claes Lindh, Lars Egevad. Karolinska Institutet, Stockholm, Sweden
Background: Prostate cancer is notoriously difficult to see at gross examination. This makes cutting of surgical specimens and biobanking more challenging than for tumors of other sites. This is to our knowledge the first systematic report on macroscopic features of prostate cancer in a large series of unfixed specimens.
Design: A set of 515 radical prostatectomy specimens were examined macroscopically by a trained pathologist (LE) at the Karolinska University Hospital 2002-2010. Unfixed prostates were bisected horizontally through the level of palpable nodules, positive preoperative biopsies or the junction of mid-apical thirds. Findings suggestive of cancer on cut surfaces were noted on a schematic drawing. Distinct findings were classified as conclusive for cancer and described as tan, white, yellow or orange while more subtle changes were classified as suspicious. Specimens were totally embedded. Tumor was outlined, all slides digitized and tumor maps were compared with gross descriptions. Tumor foci at the level of inspection were classified as minimal (<2 mm) or substantial (>2 mm).
Results: At gross examination, areas conclusive or suspicious for cancer were seen in 52% and 24%, respectively. Substantial cancers were found in 94% of conclusive foci and in 69% of suspicious foci. When no cancer was seen grossly, substantial cancers were found somewhere on the cut surface in 56%. In the entire series, substantial and minimal cancers were found anywhere at the level of macroscopic inspection in 85% and 9%, respectively. Of substantial tumors 58% had distinct gross findings (29% tan, 31% white, 16% yellow and 24% orange) and 20% were macroscopically suspicious. Among substantial cancers that were not seen at gross examination, 56% were PZ tumors and 35% TZ tumors compared to 73% and 18%, respectively, of all tumors (p = 0.005).
Conclusions: Findings conclusive for cancer at gross examination predict microscopic cancer in 94%. Of cancers larger than 2 mm 58% have distinct gross findings. TZ tumors are more difficult to see macroscopically than PZ tumors.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 113, Monday Afternoon