This educational pathology presentation, part of a "Grossing Rounds" series, focuses on the handling, pathology, and staging of a radical prostatectomy specimen, typically removed due to Prostate Adenocarcinoma. The video details the normal anatomy, including location relative to the bladder and rectum, and defines key landmarks (base, apex, seminal vesicles). A significant portion of the discussion is dedicated to the epidemiology of prostate cancer (most common cancer in Canadian men, 91% 5-year survival) and its typical location (75-80% in the peripheral zone), contrasted with Benign Prostatic Hyperplasia (BPH) found in the transitional zone. The presentation outlines the standard grossing protocol, including formalin injection, precise inking conventions (blue for right, black for left, green anterior strip), and specific sectioning techniques for the mid-prostate (transverse slices) versus the apex and base (perpendicular sections). Finally, the video reviews the pT staging system, emphasizing that pT3b corresponds to seminal vesicle invasion, and touches upon critical prognostic factors like Gleason score and margin status.
Radical Prostatectomy Grossing and Pathology Review
0:45 Specimen Identification and Anatomy: The specimen is identified as a radical prostatectomy. The prostate is normally the size of a walnut but the specimen presented is closer to a small tennis ball (0:12). Key components include the prostate gland, seminal vesicles, and vas deferens (0:36). Key landmarks are the base (superior, where the bladder stopped) and the apex (inferior).
2:48 Prostate Adenocarcinoma: This is the most common malignancy of the prostate gland. It affects approximately one in eight Canadian men, but has a high 5-year survival rate (91%), meaning most men die with prostate cancer rather than from it (3:16).
3:54 Common Cancer Location (Key Takeaway): 75-80% of prostate cancers arise in the peripheral zone of the prostate gland (4:04). The transitional zone is the second most common site (13-20%).
5:15 Genetic Risk Factors:BRCA2 and MSH2/MLH1 (Lynch syndrome) are associated with an increased risk of prostate cancer. The APC mutation (Familial Adenomatous Polyposis) is not associated with prostate cancer risk (5:15–5:59).
6:06 Benign Prostatic Hyperplasia (BPH): BPH, a benign nodular enlargement, occurs primarily in the transitional zone (6:15). It causes compression of the urethra, leading to urinary symptoms (6:42). Treatment is typically a TURP (Transurethral Resection of the Prostate).
7:18 Concerning Features for Cancer (Grossly): In a TURP specimen, signs concerning for malignancy are yellow coloration or white, firm areas (7:55).
9:24 Specimen Preparation: The specimen should be weighed and injected with formalin into all four quadrants, ensuring even distribution to prevent distortion, allowing the parenchyma to fix before grossing (9:31).
10:56 Institutional Inking Protocol: The right half is inked blue, the left half is inked black, and a green anterior strip is applied down the center (11:08).
11:33 Sectioning the Specimen: Start by removing the seminal vesicles and vas deferens (11:35). The mid-prostate is sectioned into 0.3–0.4 cm thick transverse parallel slices (12:04). The Apex and Base are sectioned perpendicularly (0.5 cm thick), starting by cutting straight through the center of the urethra (12:57).
14:44 Submission Criteria (Key Takeaway): If the prostate gland is less than 50 grams, it is submitted entirely. If it is over 50 grams (like the 80g example), alternating slices are submitted. The Apex and Base must always be submitted entirely (14:47–15:13). Submission of slices is done in a clockwise fashion.
17:18 pT Staging: Staging starts at T2 (organ confined). T3a is extra-prostatic extension. T3b (Key Takeaway) is when the tumor invades the seminal vesicles (17:41). T4 involves invasion of adjacent structures like the rectum or bladder (17:49).
18:04 Prognostic Factors: A worse prognosis is associated with larger tumor size, a higher Gleason score (grade), positive margin status, and aggressive morphologies like cribiform or intraductal carcinoma (18:08-18:39).