Wael Sakr, M.D. and David Grignon, M.D., Wayne State University, Detroit, MI
Pathologists are handling increasing numbers of prostate needle biopsies and radical prostatectomy specimens and many are required to evaluate prostate tissue samples following radiation or hormone therapy. With the definite shift towards diagnosing earlier stage, smaller volume cancers, we are frequently challenged with issuing diagnoses on earlier, often equivocal neoplastic changes. The task is coupled with the need to classify these changes consistently and communicate their significance to the clinician in non-confusing terminology. The impact of thorough evaluation of the needle biopsy-diagnosed cancer on patient management cannot be overemhasized as cumulative data in recent years clearly indicate the importance of pre-treatment pathologic findings on management decisions.
This course will detail the guidelines of handling and processing needle biopsies and list the parameters to be gleaned and reported following the diagnosis of cancer in this limited sample. Naturally, the starting point will be establishing the minimum criteria required for the diagnosis of cancer, discuss mimickers and differential diagnoses, including the role for current and emerging ancillary studies in aiding the pathologists’ assessment. A review of Gleason scoring with emphasis on the contemporary approach to the application of this system will be presented. Equally important is the issue of precursor lesions and morphologic entities associated with an increased risk of cancer detection on repeated biopsies. A comprehensive coverage of these entities, their diagnostic criteria, their clinical significance, and the way they need to be reported will be offered.
The radical prostatectomy procedure continues to be a major treatment option for patients diagnosed with prostate cancer in the last decade; this has resulted in a deluge of such specimens in academic and community pathology laboratories. Specimen handling, sampling, processing, and accurately establishing pathologic stage following this important procedure will be discussed.
The morphologic alterations induced by radiation treatment and hormone therapy will be covered, including the diagnostic approach, terminology and the potential role for ancillary studies. Finally, a brief review of the potpourri of “new molecular and prognostic markers” proposed in recent years, some with a claim of predicting progression and/or treatment response will be offered.
The course will utilize a case-study approach and will be suitable for general pathologists, residents and fellows. A CD-ROM with images selected to simulate the interpretation of needle biopsy and other types of specimens will be available for mailing to pre- registrants. A second, more comprehensive CD-ROM illustrating additional examples of lesions discussed during the course will be mailed after the meeting to all registrants for the course. A syllabus will be distributed at the course.