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Transurethral resection of the prostate (TURP) is still a common urologic procedure that is primarily used in current practice for the surgical management of benign prostatic hyperplasia. The quantity of tissue chips received in the pathology laboratory for examination varies. Recommendations by the College of American Pathologists (CAP) require submission of specimens weighing 12 g or less in their entirety, usually in 6 to 8 cassettes. (1-2) For specimens greater than 12 g, the initial 12 g should be submitted, and 1 cassette for every additional 5 g may be submitted. The CAP Cancer Committee recently added a recommendation that "if an unsuspected carcinoma is found in the tissue submitted and it involves 5% or less of the tissue examined, the remaining tissue is generally submitted for microscopic examination." (1) Most recently, this approach was seconded by a pathology expert group for the Association of Anatomic and Surgical Pathology. (3) However, controversy exists as to how much additional sampling is required to ensure an accurate tumor volume estimate and to ascertain the Gleason score in the resected specimen when unsuspected cancer is identified in a TURP sample. (4-11) Patients with incidental tumors found on histology involving 5% or less of resected tissue (stage T1a) require no further invasive treatment, particularly in patients older than age 60 years. (12) The reported clinical disease progression rate of T1a tumors is low and varies from 8% to 27%. (13-18) Older studies, before the prostate-specific antigen era, show that only 4% of patients with T1a tumors will have disease progression in 4 years, while in 16% to 25% the tumors will progress in 8 to 10 years after the TURP. (13,14,19) In contrast, patients with T1b tumors, which involve more than 5% of the resected tissue, are considered at much higher risk for disease progression (33% in 1 study) (14) and usually require additional treatment. (20) Therefore, accurate substaging of T1 disease is important and mandates different patient care. Studies performed prior to the prostate-specific antigen era showed that 90% to 100% of the incidental tumors of both stages T1a and T1b will be detected if 5 to 8 blocks or 12 g of tissue are submitted and indicated that it is not necessary to put through the whole tissue. (5-7) However, some early studies advocated complete tissue submission in all cases. (4)

Health, Mind & Body
August 1
College of American Pathologists
The Gale Group, Inc., a Delaware corporation and an affiliate of Cengage Learning, Inc.

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