Reporting parameters for positive prostate needle biopsy

According to college of American pathologists (CAP)the mandatory items for reporting positive prostate biopsies are:

• Histologic type - typically adenocarcinoma (conventional/acinar, not otherwise specified)
• Histologic grade –primary (predominant) Gleason pattern + secondary (worst remaining) Gleason pattern
• Total Gleason score
• Tumour Quantitation - 3 possible methods for tumor qyuantification;
  1) % of prostatic tissue involved by tumour
  2 ) total linear mm of carcinoma
• 3) number of positive cores/total number of cores
  
• Periprostatic fat and seminal vesicle invasion should always be looked for and reported if identified, given their importance in developing an optimal treatment plan.

Optional parameters

• Reporting the presence or absence of perineural invasion and lymphatic/small vessel invasion is completely optional.


• Perineural invasion is of debatable prognostic significance and we likely continue to reported simply because we have always done so.


• Reporting the presence of high grade PIN in biopsies with adenocarcinoma is also completely optional.


• Interestingly, inflammation is listed as an optional item. It has been my experience that many clinicians will be interested in knowing about coexisting inflammation in positive biopsies (especially if it is appreciable in amount) as it may be of use in interpreting serum PSA at the time of the positive biopsy.