Guidelines for the macroscopic processing of radical prostatectomy and pelvic lymphadenectomy specimens

Prostate cancer, with a prevalence of 9.6% and 679 000 cases diagnosed in 2002, is the third most common cancer worldwide.1 In the UK, it is the most common male cancer, representing 23% of all new cancer diagnoses, and is a major source of morbidity and mortality, causing 10 000 deaths in 2005.2 Over the past two decades, the incidence of prostate cancer has risen due to its more frequent diagnosis by a combination of serum prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and transrectal ultrasound (TRUS)-guided biopsy. In the UK, 5-year survival has improved from 31% in the 1970s to 71% in 2001,2 a finding attributed to the earlier detection of tumours, many of which behave indolently, and improvements in treatment. Although treatment of such “screening detected” cancers remains controversial, advances in surgical technique, facilitating postoperative preservation of continence and potency, mean that radical prostatectomy (RP) is increasingly offered as treatment of choice. The consequent increase in RP and pelvic lymphadenectomy (PLA) specimens received by pathology departments poses significant resource implications, highlighting the importance of effective and efficient specimen processing.

The biological behaviour of prostate cancer is heterogeneous and its underlying molecular mechanisms are poorly understood. Factors that might reliably predict outcome for individual patients (facilitating management and prognostication) have been identified and evaluated by two recent international consensus conferences.3 4 The first, organised by the College of American Pathologists (CAP),3 analysed and stratified existing predictive factors into one of three categories based on the strength of published evidence and opinions of its Prostate Working Group (table 1). The second, organised by the World Health Organization (WHO),4 concentrated on biopsy derived predictive factors. It ratified the CAP ranking and recommended the mandatory adoption in clinical practice of all category I factors, advised local discretion with …