Pathological analysis of the prostatic anterior fat pad at radical prostatectomy: insights from a prospective series

Ball, Mark W.; Harris, Kelly T.; Schwen, Zeyad; Mullins, Jeffrey K.; Han, Misop; Walsh, Patrick C.; Partin, Alan W.; Epstein, Jonathan I.

doi:10.1111/bju.13654

Cited by 13 publications

(5 citation statements)

References 22 publications

(54 reference statements)

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“…In the APPF specimens, the mean ± SD volume of fat was 12 ± 13 cm 3 (range 1-66 cm 3 ). In 234 (87%) specimens, the APPF consisted of mature fat only.…”

Section: Resultsmentioning

confidence: 98%

“…Previously published data series have demonstrated positive cancer detection in APPF in 0.6-2.5% of specimens. [1][2][3][4][5][6][7][8][9] These positive yields have mostly been detected in high-risk patients such as those with a high Gleason score, evidence of extra-prostatic extension (EPE) or positive pelvic LNs. As such, the additional staging information obtained through the histopathological analysis of APPF in high-risk patients may not add further prognostic information.…”

Section: Introductionmentioning

confidence: 99%

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The impact of histopathological analysis of anterior peri-prostatic fat in radical prostatectomy patients

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Nesbitt

Ravichandran

et al. 2019

Journal of Clinical Urology

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Objective: To determine the usefulness of histopathological analysis of peri-prostatic fat in a cohort of prostate cancer patients undergoing radical prostatectomy (RP) in an Australian regional centre. During RP, removal of the anterior peri-prostatic fat (APPF) is commonly undertaken; some surgeons routinely request histopathological analysis of this specimen. Previously published data show positive cancer detection in peri-prostatic fat in 0–2.5% of specimens and positive yields are mostly detected in patients with adverse pathological features. Subjects and methods: All patients undergoing RP in a regional urology unit in Queensland were identified. Pathology results were examined retrospectively to determine the rate of cancer involvement in APPF specimens and medical records were reviewed to assess any clinical impact. Results: APPF was sent for pathological analysis in 270/298 (90%) of patients undergoing RP. Prostate cancer was detected in one sample containing a single involved lymph node in a patient with Gleason 5 + 4 = 9 prostate cancer and pathological stage pT3bN1R1Mx. The presence of the cancer in the APPF did not affect the decision to offer adjuvant radiotherapy. Conclusion: In our population, we have identified a positive cancer yield of 0.3% in APPF specimens. When combined with all previously published series, we found positive cancer detection in 72/7391 (1%) specimens, and most patients with positive fat involvement had adverse pre-operative and final pathological features. Surgeons may consider omitting sending APPF specimens for analysis based on the low yield with little additional staging information. If surgeons continue this practice, they should consider selectively requesting analysis in intermediate- and high-risk patients. Level of evidence: 2b

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“…In the APPF specimens, the mean ± SD volume of fat was 12 ± 13 cm 3 (range 1-66 cm 3 ). In 234 (87%) specimens, the APPF consisted of mature fat only.…”

Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

The impact of histopathological analysis of anterior peri-prostatic fat in radical prostatectomy patients

Filby

Nesbitt

Ravichandran

et al. 2019

Journal of Clinical Urology

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“…Similarly, fat‐clearing agents to aid LN harvesting were not in common use by pathologists completing the survey. Just over half of survey respondents also received anterior fat pad tissue, which is sometimes removed during robotic RP and may harbour LNs . There are currently no guidelines regarding the pathological sampling of these specimens and the majority of participants embedded all tissue.…”

Section: Discussionmentioning

confidence: 99%

Handling and reporting of pelvic lymphadenectomy specimens in prostate and bladder cancer: a web‐based survey by the European Network of Uropathology

et al. 2019

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Aims: Pathological evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node (LN) staging. Guidelines standardising the gross handling and reporting of pelvic LN dissection (PLND) in prostate (PCa) and bladder (BCa) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists. Methods and results: A web-based survey was circulated to all members of the European Network of Uropathology (ENUP), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PCa and BCa. Two hundred and eighty responses were received from pathologists throughout 23 countries. Only LNs palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10 LNs in 56% and <10 LNs in 44%.Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents, respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN+ cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits (pN0) by 36% and replaced LNs (pN+) by 27%. LNs identified in periprostatic fat were included in the PLND LN count by 69%. Conclusion: This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urological malignancies. A consensus protocol may provide a framework for more consistent and standardised reporting of PLND specimens.

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“…Additional LNs can be retrieved in the medial branches of the hypogastric artery in what can easily be ignored as perivesical fat. Some of this tissue joins the ‘anterior fat’ that some surgeons have reported as containing a few LNs and occasional pN1 . Therefore, E‐PLND is not always ‘complete’ PLND and performance of the latter could easily turn into a 2‐h procedure and perhaps additional co‐morbidity.…”

Section: Discussionmentioning

confidence: 99%

Surgeon‐led prostate cancer lymph node staging: pathological outcomes stratified by robot‐assisted dissection templates and patient selection

et al. 2018

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Pathological analysis of the prostatic anterior fat pad at radical prostatectomy: insights from a prospective series

Abstract: Metastatic PAFP LNs are rare and always occur in the presence of other adverse pathological features. The routine pathological analysis of PAFP as a separate specimen, especially in low-risk disease, may not be warranted.

Cited by 13 publications

References 22 publications

The impact of histopathological analysis of anterior peri-prostatic fat in radical prostatectomy patients

The impact of histopathological analysis of anterior peri-prostatic fat in radical prostatectomy patients

Handling and reporting of pelvic lymphadenectomy specimens in prostate and bladder cancer: a web‐based survey by the European Network of Uropathology

Surgeon‐led prostate cancer lymph node staging: pathological outcomes stratified by robot‐assisted dissection templates and patient selection

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