This course will provide an update on several specific issues of practical importance in the routine practice of diagnostic prostate pathology. Our discussions will be introduced by case presentations that highlight these important issues. First, we will address the diagnosis of prostatic adenocarcinoma on biopsy. This will include benign morphologic mimics of cancer, subtle patterns of adenocarcinoma, the use of adjunctive immunohistochemistry, and a discussion of diagnosing minimal carcinoma. Second, we will provide an update on Gleason scoring that is based on the ISUP 2005 consensus modifications. We will specifically address the difficulties that arise in the daily application of the Gleason system and provide our approach to handling difficult cases. Third, we will discuss reporting guidelines for biopsies and radical prostatectomies with emphasis on reporting volume and Gleason score. Finally, we will review the staging of prostate cancer in radical prostatectomy specimens based on the ISUP 2010 consensus statement. The clinical significance of each diagnostic distinction will be emphasized throughout.

This course is designed for general surgical pathologists and pathologists in training who are seeking an approach to the practical issues that arise in the daily diagnostic practice of prostate specimen interpretation. We will provide a detailed written syllabus as well as images of the full spectrum of pathologic changes presented.

Upon completion of the course, participants should be able to: 1) Confidently approach the differential diagnosis of atypical glandular lesions in prostate needle core biopsies; 2) Establish an approach to using adjunctive immunohistochemistry for the diagnosis of prostatic adenocarcinoma; 3) Recognize the full spectrum of Gleason patterns and develop an approach to difficult threshold cases; and 4) Confidently stage prostatic adenocarcinoma in radical prostatectomy specimens.

This course may be used for CME credits or SAM credits.