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Open Access 17-06-2022 | Prostate Cancer | Original Article

The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better?

Authors: Jens Köllermann, Benedikt Hoeh, Daniel Ruppel, Kevin Smith, Henning Reis, Mike Wenzel, Felix Preisser, Marina Kosiba, Philipp Mandel, Pierre I. Karakiewicz, Andreas Becker, Felix K. H. Chun, Peter Wild, Luis A. Kluth

Published in: Virchows Archiv | Issue 3/2022

Abstract

The aim of this study is to investigate the incidental prostate cancer (iPCa) detection rates of different embedding methods in a large, contemporary cohort of patients with bladder outlet obstruction (BOO) treated with transurethral surgery. We relied on an institutional tertiary-care database to identify BOO patients who underwent either transurethral loop resection or laser (Holmium:yttrium–aluminium garnet) enucleation of the prostate (HoLEP) between 01/2012 and 12/2019. Embedding methods differed with regard to the extent of the additional prostate tissue submitted following the first ten cassettes of primary embedding (cohort A: one [additional] cassette/10 g residual tissue vs. cohort B: complete embedding of the residual tissue). Detection rates of iPCa among the different embedding methods were compared. Subsequently, subgroup analyses by embedding protocol were repeated in HoLEP-treated patients only. In the overall cohort, the iPCa detection rate was 11% (46/420). In cohort A (n = 299), tissue embedding resulted in a median of 8 cassettes/patient (range 1–38) vs. a median of 15 (range 2–74) in cohort B (n = 121) (p < .001). The iPCa detection rate was 8% (23/299) and 19% (23/121) in cohort A vs. cohort B, respectively (p < .001). Virtual reduction of the number of tissue cassettes to ten cassettes resulted in a iPCa detection rate of 96% in both cohorts, missing one stage T1a/ISUP grade 1 carcinoma. Increasing the number of cassettes by two and eight cassettes, respectively, resulted in a detection rate of 100% in both cohorts without revealing high-grade carcinomas. Subgroup analyses in HoLEP patients confirmed these findings, demonstrated by a 100 vs. 96% iPCa detection rate following examination of the first ten cassettes, missing one case of T1a/ISUP 1. Examination of 8 additional cassettes resulted in a 100% detection rate. The extent of embedding of material obtained from transurethral prostate resection correlates with the iPCa detection rate. However, the submission of 10 cassettes appears to be a reasonable threshold to reduce resource utilization while maintaining secure cancer detection.

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Title: The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better?
Authors: Jens Köllermann
Benedikt Hoeh
Daniel Ruppel
Kevin Smith
Henning Reis
Mike Wenzel
Felix Preisser
Marina Kosiba
Philipp Mandel
Pierre I. Karakiewicz
Andreas Becker
Felix K. H. Chun
Peter Wild
Luis A. Kluth
Publication date: 17-06-2022
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Transurethral Prostate Resection
Laser
Published in: Virchows Archiv / Issue 3/2022
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-022-03331-6

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The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better?

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