How Much Tissue Sampling Is Required When Unsuspected Minimal Prostate Carcinoma Is Identified on Transurethral Resection?

Abstract

Abstract Context.—When minimal prostate cancer is detected in the initial transurethral resection of the prostate (TURP) sample, it is uncertain how extensively the remaining tissue should be sampled for accurate grading and staging. Objective.—To identify whether additional partial or complete sampling is required to accurately evaluate TURP samples with minimal cancer (stage T1a). Design.—We prospectively examined all TURP samples in our institution during 1 year. All specimens were sampled randomly in 6 cassettes. When minimal cancer was found, we performed additional partial sampling (1 block per 5 g of remaining tissue), followed by complete submission of all remaining tissue. All samples were evaluated separately to identify possible changes in Gleason score and tumor volume. We performed a cost analysis for the additional tissue sampling. Results.—Of 747 TURP samples evaluated on the initial 6 cassettes, 125 (16.7%) contained prostate cancer. Minimal cancer involving less than 5% of sampled tissue was found in the initial submission in 26 (3.5%) patients. Additional partial examination required 3.5 blocks per case (median; range, 1–23), while complete processing required an additional 5.5 blocks per case (median; range, 2–25). Initial Gleason scores and tumor volumes were not changed in any of the studied cases after evaluating the additional partial and complete samples. In our laboratory, we calculated a cost of $4336 per year for the additional sampling of TURPs with minimal cancer ($1681 for partial and $2655 for complete sampling). Conclusions.—When minimal cancer was found in the first 6 cassettes of transurethral resections, additional partial and complete sampling did not change the initial Gleason scores and tumor volumes.