Protocol for the Examination of Specimens From Patients With Carcinoma of the Prostate Gland

Abstract

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.This protocol applies to invasive carcinomas of the prostate gland. The 7th edition TNM staging system for carcinoma of the prostate of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) is recommended.Select a Single Response Unless Otherwise Indicated* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.Note: The Gleason grade and score and the tumor extent measures should be documented for each positive specimen (container). The essential information in each specimen could be conveyed with a simple diagnostic line such as, “Adenocarcinoma, Gleason grade 3 + 4 = score of 7, in 1 of 2 cores, involving 20% of needle core tissue, and measuring 4 mm in length.” (See “Explanatory Notes.”)Histologic Type (note A)__ Adenocarcinoma (acinar, not otherwise specified)__ Other (specify): ____Histologic Grade (note B)Gleason Pattern(If 3 patterns present, use most predominant pattern and worst pattern of remaining 2)__ Not applicable__ Cannot be determinedPrimary (Predominant) Pattern__ Grade 1__ Grade 2__ Grade 3__ Grade 4__ Grade 5Secondary (Worst Remaining) Pattern__ Grade 1__ Grade 2__ Grade 3__ Grade 4__ Grade 5Total Gleason Score: __Tumor Quantitation (note C)Number cores positive: __Total number of cores: __ andProportion (percentage) of prostatic tissue involved by tumor: __orNumber cores positive: __Total number of cores: __ andTotal linear millimeters of carcinoma: __ mmTotal linear millimeters of needle core tissue: __ mmorNumber cores positive: __Total number of cores: __ andProportion (percentage) of prostatic tissue involved by tumor: __ andTotal linear millimeters of carcinoma: __ mmTotal linear millimeters of needle core tissue: __ mm*Proportion (percentage) of prostatic tissue involved by tumor for core with the greatest amount of tumor: __%Periprostatic Fat Invasion (document if identified) (note D)*__ Not identified__ PresentSeminal Vesicle Invasion (document if identified) (note D)*__ Not identified__ Present*Lymph-Vascular Invasion*__ Not identified*__ Present*__ Indeterminate*Perineural Invasion (note E)*__ Not identified*__ Present*Additional Pathologic Findings (select all that apply)*__ None identified*__ High-grade prostatic intraepithelial neoplasia (PIN) (note F)*__ Atypical adenomatous hyperplasia (adenosis)*__ Inflammation (specify type): ____*__ Other (specify): ____*Comment(s): ____Select a Single Response Unless Otherwise Indicated* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.Procedure__ Transurethral prostatic resection (note G)__ Enucleation__ Other (specify): ______ Not specifiedSpecimen SizeWeight: __ gSize (enucleation specimens only): __ × __ × __ cmHistologic Type (note A)__ Adenocarcinoma (acinar, not otherwise specified)__ Other (specify): ____Histologic Grade (note B)Gleason Pattern(If 3 patterns present, use most predominant pattern and worst pattern of remaining 2)__ Not applicable__ Cannot be determinedPrimary (Predominant) Pattern__ Grade 1__ Grade 2__ Grade 3__ Grade 4__ Grade 5Secondary (Worst Remaining) Pattern__ Grade 1__ Grade 2__ Grade 3__ Grade 4__ Grade 5Total Gleason Score: __Tumor Quantitation: TUR Specimens (note C)Proportion (percentage) of prostatic tissue involved by tumor: __%__ Tumor incidental histologic finding in no more than 5% of tissue resected with Gleason score 2 to