808 Histological Sampling Protocols for Transurethral Resection of Prostate Specimens

Document Type

Conference Proceeding

Publication Date

3-24-2025

Publication Title

Lab Invest

Keywords

aged, bladder obstruction, conference abstract, diagnosis, endoscopic surgery, female, histology, holmium laser enucleation of the prostate, human, human tissue, lower urinary tract symptom, male, prevalence, prostate cancer, prostate carcinoma, prostate hypertrophy, protocol, retrospective study, surgery, transurethral resection, workload

Abstract

Disclosures: Gamze Gokturk Ozcan: None; Mohamed Alhamar: None; Vipulkumar Dadhania: None; Oudai Hassan: None; Nilesh Gupta: None; Khaleel Al-Obaidy: None Background: Lower urinary tract symptoms (LUTS) due to bladder outlet obstruction associated with benign prostatic hyperplasia (BPH) are among the most common conditions in men, and their prevalence increases with age. Transurethral resection of the prostate (TURP) has been the gold standard for the surgical treatment of LUTS. As an alternative to TURP, other treatment technologies have been introduced, such as holmium laser enucleation of the prostate (HoLEP). Incidental prostate carcinoma (PCA) can be seen in up to 10% of TURP specimens, with the majority being Grade Group (GG) 1. Current guidelines recommend submitting the entire specimen for cases involving less than 12 grams (six blocks), with an additional 2 grams (one block) for each additional 5 grams beyond the initial 12 grams. Oversampling can lead to increased workload for both the laboratory and the pathologist. Design: From our institutional database, patients treated with endoscopic surgery (TURP, HoLEP) for LUTS were retrospectively selected between 2015 and 2022. Patients with histologically confirmed prostate cancer were included. All H&E and IHC slides were reviewed. Results: A total of 2,508 patients were included, of whom 150 (6%) were diagnosed with PCA on TURP (n=111) or HoLEP (n=39). The mean age was 73 (49-97 years). The mean resected tissue volume was 27.1 grams, the mean initial submitted block count was 12 (1-40). GG1 was the most common tumor type (n=72, 48%), followed by GG2 (n=32, 21.4%), GG3 (n=8, 5.3%), GG4 (n=2, 1.3%), and GG5 (n=34, 22.7%). Two patients had a treatment history, grading wasn`t performed. 72 patients with GG1, 53/72 (74%) and 66/72 (92%) were detected in the first 5 and first 10 blocks, respectively. All patients with GG2 and GG3 were detected in the first 5 blocks (40/40, 100%). Finally, of the 36 patients with GG4 and GG5, 35 (97%) were detected in the first 5 blocks, the remaining one identified in the 7th cassette, which had very low tumor content (5%). Thus, all GG4 and GG5 patients were detected in the first 10 blocks. Two patients with treatment effects were detected in the first 5 blocks (2/2, 100%). [Formula presented] Conclusions: In our cohort, PCA detected in TURP/HoLEP specimens was mainly of the GG1 category, the vast majority of which could be detected in the first 10 blocks. Similarly, all clinically significant PCA (GG2 and higher) could be detected in fewer cassettes than the current protocol requires. Therefore, in our opinion, current sampling protocols for TURP/HoLEP specimens need to be reevaluated.

Volume

105

Issue

3

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