title: Complete embedding and close step-sectioning of radical prostatectomy specimens both increase detection of extra-prostatic extension, and correlate with increased disease-free survival by stage of prostate cancer patients.
abstract: The objectives of this work were to evaluate the efficacy of controlled close step-sectioned and whole-mounted radical prostatectomy specimen processing in prediction of clinical outcome as compared to the traditional processing techniques. Two-hundred and forty nine radical prostatectomy (RP) specimens were whole-mounted and close step-sectioned at caliper-measured 2.2-2.3 mm intervals. A group of 682 radical prostatectomy specimens were partially sampled as control. The RPs were performed during 1993-1999 with a mean follow-up of 29.3 months, pretreatment PSA of 0.1-40, and biopsy Gleason sums of 5-8. Disease-free survival based on biochemical or clinical recurrence and secondary intervention were computed using a Kaplan-Meier analysis. There were no significant differences in age at diagnosis, age at surgery, PSA at diagnosis, or biopsy Gleason between the two groups (P<0.05). Compared with the non-close step-sectioned group, the close step-sectioned group showed higher detection rates of extra-prostatic extension (215 (34.1%) vs, 128 (55.4%), P<0.01), and seminal vesicle invasion (50 (7.6%) vs 35 (14.7%), P<0.01). The close step-sectioned group correlated with greater 3-y disease-free survival in organ-confined (P<0.01) and specimen-confined (P<0.01) cases, over the non-uniform group. The close step-sectioned group showed significantly higher disease-free survival for cases with seminal vesicle invasion (P=0.046). No significant difference in disease-free survival was found for the positive margin group (P=0.39) between the close step-sectioned and non-uniform groups. The close step-sectioned technique correlates with increased disease-free survival rates for organ and specimen confined cases, possibly due to higher detection rates of extra-prostatic extension and seminal vesicle invasion. Close step-sectioning provides better assurance of organ-confined disease, resulting in enhanced prediction of outcome by pathological (TNM) stage.
authors.affiliation: Center for Prostate Disease Research (CPDR), Rockville, MD 20852, USA.
authors.forename: A
authors.initials: A
authors.lastname: Desai
authors.forename: H
authors.initials: H
authors.lastname: Wu
authors.forename: L
authors.initials: L
authors.lastname: Sun
authors.forename: I A
authors.initials: IA
authors.lastname: Sesterhenn
authors.forename: F K
authors.initials: FK
authors.lastname: Mostofi
authors.forename: D
authors.initials: D
authors.lastname: McLeod
authors.forename: C
authors.initials: C
authors.lastname: Amling
authors.forename: L
authors.initials: L
authors.lastname: Kusuda
authors.forename: R
authors.initials: R
authors.lastname: Lance
authors.forename: J
authors.initials: J
authors.lastname: Herring
authors.forename: J
authors.initials: J
authors.lastname: Foley
authors.forename: D
authors.initials: D
authors.lastname: Baldwin
authors.forename: J T
authors.initials: JT
authors.lastname: Bishoff
authors.forename: D
authors.initials: D
authors.lastname: Soderdahl
authors.forename: J W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016610:Tissue Embedding / Q000379:methods*