International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

Abstract

The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling

“…The results of the individual working group reports related to T2 substaging, extraprostatic extension, seminal vesicle and lymph node involvement and margin status are reported separately. [13][14][15][16] Many recommendations of this consensus conference have already been incorporated into international guidelines, including the recent College of American Pathologists protocol and checklist for reporting adenocarcinoma of the prostate and the structured reporting protocol for prostatic carcinoma from the Royal College of Pathologists of Australasia. 17,18 Specimen transportation Typically, radical prostatectomy specimens are transported in 10% buffered formal saline.…”

Controversial predictors of biochemical recurrence after radical prostatectomy: a study from a Latin American (Brazilian) Institution

“…During the International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens held in Boston during the 98th meeting of the United States and Canadian Academy of Pathology (USCAP), no consensus could be reached as to how evaluate extent of EPE and PSM (27,28). In this study we evaluated the influence of focal and diffuse EPE and PSM on TBR using a simple method for EPE and PSM extent quantitation that can be used in the daily practice of all pathologists who step section and totally process the surgical specimen.…”

“…However, the amount of EPE and PSM seems to be more important than a simple report of presence or absence of these pathological findings. An additional concern is the absence of consensus among pathologists how to evaluate the amount of EPE and PSM (27,28).…”

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes

“…The results of the individual working group reports related to specimen handling, T2 substaging, extraprostatic extension, seminal vesicle and lymph node involvement and margin status are reported separately. [12][13][14][15] Many recommendation of this consensus conference have already been incorporated into international guidelines, including the recent College of American Pathologists protocol and checklist for reporting adenocarcinoma of the prostate and the structured reporting protocol for prostatic carcinoma from the Royal College of Pathologists of Australasia. 16,17 Seminal vesicle invasion…”