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Purpose

Radical prostatectomy is performed after cancer has been found by needle core biopsy or less commonly,when the gland is severely hypertrophied due toBPH.Most prostatectomiesperformed here arerobot assisted-laparoscopic(otherwise known as Da Vinci prostatectomy). The open prostatectomyprocedure israrely used.The Da Vinci techniqueismuch less invasive, decreasing recovery time, infection,and bleeding.

Orientation tip: the seminal vesicles and vasadeferentiaare attached to the baseon the superior-posterior aspect!

Procedure

  • Measure: length x width xheight
  • Weight
  • Measure both left/right vas deferens and left/right seminal vesicles
  • Ink:ALWAYSINKTHE PROSTATEIN THEFOLLOWING SCHEME:
  • GREEN-RIGHTHALF
  • BLUE-LEFT HALF
  • YELLOW-Prostate/BLADDER
  • RED– false margin under staple line (see below)
  • BLACK– Anterior aspect of DUM
  • (this also includes left and right seminal vesicles and vas deferens).The anterior margin is inked black(required fordistal apex margins sections- see below for details).
  • Cassette Key (see template below):Start with rightsectionsfollowed byleft.
  • Please see the“Whole mount Prostate grossing template”for details of cassettedesignations and followthem.
  • Double check to make sure that cassette numbers have correct accession and part numbers.
  • Staples:Almost all prostatectomies contain sutures ormultiple staples onthe anterior aspect.
  • Always ink the specimen first, and then remove thestaples.
  • Ink the exposed parenchyma with red ink to denote the false margin.
  • Note this in the comment section of the template.
  • Pleasesee a power-point“Whole Mount Prostates”inthecuttingmanualfor figures
  • SV and VD:Amputatethe seminalvesicles and the vas deferens at the base.
  • Seriallysection forabnormalities
  • PlaceR and Lseminal vesicletissue at the point ofattachmentto prostatein the assigned cassette(basemost section of eachseminal vesicle).
  • Proximal Urethral Margin (PUM):Transect bladder base(proximal urethral margin, PUM) andradially section around urethra
  • submit in 4 cassettes labelled:
  • Ant RightPUM
  • Ant Left PUM
  • Post RightPUM
  • Posterior LeftPUM
  • Distal Urethral Margin:Transect apex(distalurethral margin DUM) and section radiallyaround theurethra(likeacervical cone).
  • Inkthe anterioraspect oftheapex withblackink (ifnot done earlier).
  • Submit in two cassettes:
  • Right DUM
  • Left DUM
  • Sections:Sectionthe remaininggland from base to apex (anterior to posterior) atapproximately 5mm thickness,taking care to retain inkedmargins.
  • Remove any residual staples or calculi
  • Lay out all the slices in proper order from base to apex, with basemost whole mount sectionconsidered as slice 1(seethe power –point for images).
  • Whole Mount:Every other slice will be submittedin a WM,alwaysincluding the last.
  • Example:Aprostate with 7 sections: 1, 3, 5 and 7 will be submittedas whole mount sections.
  • Example:A prostate with 8 sections: 1, 3, 5, 7 and 8 will be submittedas whole mount sections.
  • Capsule:For the remaining/intervening slices, core out the central prostate and submit the capsulesections
  • i.e.fortheseinterveningsections, the entire capsule must be submitted for extraprostatic extension and margin evaluation.
  • THE ENTIRE CAPSULE MUST BE SUBMITTED ON ALL PROSTATECTOMIES, WHETHEROR NOTTHEY HAVE BEEN PROCURED ON.
  • Each cassette will contain two sections of the capsule
  • (i.e., right anterior capsule and left anterior capsule of section 2 can be placed in one cassette because they will be inked differently).
  • On procured prostates, the central portions of these capsule sections MUST be banked for research; on non-procured prostates, the central portion will simply not be submitted.
  • Procured Prostates:The prostate will have been grossed while fresh;all sections must then be pinned out and fixed before being submitted.Responsibility for submitting these sections after fixation will depend oncommunication between the PAs and residents.

TIP: How is grossing different for urothelial carcinoma versus prostate carcinoma?

  • Cystectomy orCystoprostatectomywill be performed
  • Submit the distal urethral margin (DUM)enface/shave.) (NOT as perpendicular margin sections.
  • Occasionally the surgeon will have already submitted a separate specimen as the DUM, in which case you do not have to submit another shave/enface section

Standard Cassette Template