Anterior prostate fat resection during prostatectomy: a histopathologic review
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ORIGINAL ARTICLE
Anterior prostate fat resection during prostatectomy: a histopathologic review A. M. Guy1 · L. E. Kavanagh1 · E. Hart1 · B. Haagsma2 · M. J. A. Perry1 Received: 31 August 2020 / Accepted: 29 October 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract A common practice during robot-assisted radical prostatectomy (RARP) is to dissect the anterior prostate space and send this anterior fat sample for histological analysis to assess for the presence of any malignant tissue. Theoretically, this may help with prognostication and oncological control, however, is this a futile process? To determine the incidence of malignant tissue found in the anterior prostate (APF) samples sent for histological review. All RARP patients within a single urology centre over a 2-year period were included. The pathology results of these patients were reviewed and the proportion of patients with APF sent were analysed for presence of lymph nodes and malignant tissue. 657 patients were identified. 358 patients had APF samples reviewed by the histopathologists. 38 (10.6%) samples had lymph nodes identified within the sample. Malignant lymph node tissue was found in one patient (0.3%). Given the yield of malignancy found in APF samples is so small and the financial and time burden on pathology services, this process is not worthwhile. Keywords Anterior prostatic fat · Lymph nodes · Metastases · Prostate cancer · Radical prostatectomy · Robot assisted
Introduction Radical prostatectomy is the most commonly performed curative treatment for locally advanced prostate cancer [1]. Robot-assisted radical prostatectomy is the surgical technique increasingly utilised within the UK [2] due to its post-operative recovery benefits. Meanwhile, pelvic lymph node dissection at time of prostatectomy is reducing in its incidence [3] due to the lack of proof of benefit, the risk of complications, as well as new imaging modalities such PSMA PET [4]. A common practice during radical prostatectomy when dissecting the anterior prostatic space, to better identify the dorsal venous complex and bladder neck, is to resect and then send off the anterior fat for histology analysis. The reason for this is that there is a theoretical presence of lymph * A. M. Guy [email protected] 1
Stokes Department of Urology, Royal Surrey Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
Pathology Department, Royal Surrey Hospital NHS Foundation Trust, Egerton Road, Guildford, Guildford GU2 7XX, UK
2
nodes within this anterior prostatic fat (APF), which if present may contain malignant tissue. If detected, it is considered this may aid in prognostication, and possibly improve oncological control. The purpose of our study was to review the frequency of sending APF for histopathological examination at time of prostatectomy within a single centre, as well as the incidence of lymph nodes within this sample and further to that the presence of metastases. We also involved our pathology colleagues to ascertain th
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