Auto Text: “Insert Prostatectomy”
- Measure prostate in 3 dimensions.
- Measure bilateral seminal vesicles and vasa deferentia.
- Make note of any major tissue disruptions.
- Ink left side black and right side blue.
- Remove bilateral seminal vesicles and vasa deferentia.
- Weigh prostate (AFTER removal of appendages).
- Fix in formalin. Always fix overnight.
- Review the previous biopsy history noting diagnosis, volume, and location of abnormalities.
- Slice a 3 mm periurethral section from the distal (apical) resection margin.
- Serially section this apical margin and submit.
- Slice a 3 mm periurethral section from the proximal (basal) resection margin.
- Serially section this basal margin and submit.
- Serially section the remaining prostate from apex to base, in 3 mm slices perpendicular to urethral axis.
- Identify where cancer (firm, yellow, tan or white, solid, indurated) comes closest to capsule or margins.
- Submit as follows:
- If biopsies showed tumor in only ONE core with focus <=1 mm, then submit the ENTIRE prostate. If prostate weighs >100 gm, please call the attending to discuss grossing plan.
- Otherwise, submit according to weight:
- If prostate weighs up to 40 gm, submit 100%.
- If prostate weighs >40-80 gm, submit 75%.
- If prostate weights >80 gm, please call the attending to discuss grossing plan.
- ENTIRE slices should be submitted in halves, quarters, sixths, or eighths, depending on the size of the cross section (see images below and right). In a segmented cross section, ALL segments from that cross section should be submitted. See image below.
- Focus your submission on sections that show gross tumor, grossly close margins, or possible extraprostatic extension.
- Serially section and submit representative bilateral seminal vesicles and vasa deferentia.
Note on Pelvic Lymph Nodes
In cases when your gross tally of lymph nodes is less than 8 on any given side, submit at least 4 additional sections of fat. If the entire remainder of the fat can be submitted in a reasonable amount of cassettes, please do so.