Prostate: Prostatectomy

Auto Text: “Insert Prostatectomy”

Triage

  1. Measure prostate in 3 dimensions.
  2. Measure bilateral seminal vesicles and vasa deferentia.
  3. Make note of any major tissue disruptions.
  4. Ink left side black and right side blue.
  6. Remove bilateral seminal vesicles and vasa deferentia.
  7. Weigh prostate (AFTER removal of appendages).
  8. Fix in formalin. Always fix overnight.

Gross

  1. Review the previous biopsy history noting diagnosis, volume, and location of abnormalities.

  2. http://scgap.systemsbiology.net/figures/Prostate_Anatomy.php

  3. Slice a 3 mm periurethral section from the distal (apical) resection margin.
    1. Serially section this apical margin and submit.
  4. Slice a 3 mm periurethral section from the proximal (basal) resection margin.
    1. Serially section this basal margin and submit.
  5. Serially section the remaining prostate from apex to base, in 3 mm slices perpendicular to urethral axis.
  7. Identify where cancer (firm, yellow, tan or white, solid, indurated) comes closest to capsule or margins.
  9. 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.
  10. 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.

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