Guideline for Optimization of Surgical and Pathological Quality Performance for Radical Prostatectomy in Prostate Cancer Management: Evidentiary Base (Consensus Guideline) (Report‪)‬

The number of newly diagnosed cases of prostate cancer in Canada is increasing as a result of an aging population, increased public awareness, and the widespread use of prostate-specific antigen (PSA) as a tool for prostate cancer screening and early detection.[sup.1,2] Recent projections from Cancer Care Ontario (CCO) administrative data show that the incidence of prostate cancer in Ontario will increase from 9900 cases in 2005 to almost 13 500 cases in 2010. The proportion of early-staged cancers has also increased because of these factors. While radical prostatectomy (RP) is only one of the several management options for localized disease in Ontario, about 3000 RPs are performed per year, and this number is expected to increase with the demand for early-stage treatment. The main goals of RP are (a) complete eradication of the cancer-containing organ with negative surgical margins, thereby maximizing the chance of cure, (b) preservation of urinary function, and (c) preservation of erectile function, where appropriate, but, in some cases, it is not possible to achieve all these goals. The effectiveness of RP in the treatment of prostate cancer depends on good surgical and pathological management and on the effectiveness of communication between the surgical and pathological teams and other cancer care providers. Proper handling of the specimen in the operating room and complete and clear communication of information in the accompanying requisition form provide the starting point for high-quality pathological analysis and reporting of results to the surgeon and other care providers. The pathological assessment of prognostic factors (e.g., Gleason score, pathologic stage, margin status) is best accomplished through systematic handling of the surgical specimen.[sup.3] Clear and unambiguous communication of the results (particularly the prognostic factors) in the pathology report are essential for planning the subsequent treatment and care of the individual patient, for assessing the quality of surgical management (margin status), and for system planning purposes. Therefore, to attain the highest quality treatment and management for prostate cancer, both surgical and pathological procedures need to be well-integrated.