transurethral resection of the prostate
Wednesday 8 February 2012
When transurethral resection of the prostate (TURP) is done without clinical suspicion of cancer, prostate cancer is incidentally detected in approximately 8-10% of the specimens.
Cancers detected at TURP are often transition zone tumours, but they may also be of peripheral zone origin, particularly when they are large.
It is recommended that the extent of tumour is reported as percentage of the total specimen area.
If the tumour occupies less than 5% of the specimen it is stage T1a, and otherwise stage T1b. However, in the uncommon situation of less than 5% of cancer with Gleason score 7 or higher, patients are treated as if they had stage T1b disease.
Most men who undergo total prostatectomy for T1a cancer have no or minimal residual disease, but in a minority there is substantial tumour located in the periphery of the prostate.
Handling of TUR specimens
A TURP specimen may contain more than a hundred grams of tissue and it is often necessary to select a limited amount of tissue for histological examination.
Submission should be random to ensure that the percentage of the specimen area involved with cancer is representative for the entire specimen. Several strategies for selection have been evaluated.
Submission of 8 cassettes will identify almost all stage T1b cancers and approximately 90% of stage T1a tumours.
In young men, submission of the entire specimen may be considered to ensure detection of all T1a tumours.
Guidelines have been developed for whether additional sampling is needed following the initial detection of cancer in a TURP specimen.