TNM staging of prostate cancer? - 2017
- T1 Clinically inapparent tumour that is not palpable
- T1a Tumour incidental histological finding in 5% or less of tissue resected
- T1b Tumour incidental histological finding in more than 5% of tissue resected
- T1c Tumour identified by needle biopsy (e.g. because of elevated prostate-specific antigen [PSA])
- T2 Tumour that is palpable and confined within the prostate
- T2a Tumour involves one half of one lobe or less
- T2b Tumour involves more than half of one lobe, but not both lobes
- T2c Tumour involves both lobes
- T3 Tumour extends through the prostatic capsule*
- T3a Extracapsular extension (unilateral or bilateral) including microscopic bladder neck involvement
- T3b Tumour invades seminal vesicle(s)
T4 Tumour is fixed or invades adjacent structures other than seminal vesicles: external sphincter, rectum, levator muscles, and/or pelvic wall
Updates in the American Joint Committee on Cancer (AJCC) staging of prostate cancer 2018
Needle core biopsy? *
At least 10-12 systematic prostatic 18G core biopsy.
Extended biopsy - additional targeted biopsies (Digital, TRUS, MRI)
Saturation biopsy (> 20 cores) - clinical suspicion of malignancy but the standard core biospy are negative.
Length of core to be mentioned in needle biopsy? *
Guidelines for handling core biopsy? *
- Each core to be sent in separate container with site identification
- Prevent bending of core
Embedding and sectioning of specimen? *
No more than two cores embedded together
Three level of tissues
Reporting of core biopsy?
- Gleason grading system by Dr Donald Gleason (1966)
- Five architectural patterns - starting from 1-5
- Grading sum of two predominant pattern - 3+4 = 7
- Modifications - 2015 ISUP / 2016 WHO
Modifications in 2016 WHO/2015 ISUP? *
- Definitional changes -
- Gleason pattern 1 and 2, GS 2 to 5 should not be rendered, regardless of the specimen type
From practical standpoint Gleason pattern (GP) starts at 3 and GS starts at 6
- Operational changes -
- - GS - The predominant and the worst pattern irrespective of the percentage
- - If limited secondary pattern (<5%) - tumor of low grade can be ignored. The GS will be the sum of the predominant pattern.
CAP guidelines on reporting core biopsies (single core)? *
Gleason grade grouping?
GS often grouped into 3 tiers 6,7, 8-10 for therapeutic and prognostic purpose
For prognostication and management gleason grade grouping was done
- Grade group 1 - Gleason score < 6
- Grade group 2 - Gleason score 3+4 = 7
- Grade group 3 - Gleason score 4+3 = 7
- Grade group 4 - Gleason score - 8
- Grade group 5 - Gleason score 9,10
Relative abudance of pattern 4 PCa significantly impacts the prognosis.
Role of immunohistochemistry?