TY  - JOUR
A1  - Köllermann, Jens
A1  - Höh, Robert Benedikt
A1  - Ruppel, Daniel
A1  - Smith, Kevin
A1  - Reis, Henning
A1  - Wenzel, Mike
A1  - Preißer, Felix Martin
A1  - Kosiba, Marina
A1  - Mandel, Philipp
A1  - Karakiewicz, Pierre I.
A1  - Becker, Andreas
A1  - Chun, Felix
A1  - Wild, Peter Johannes
A1  - Kluth, Luis
T1  - The significance of the extent of tissue embedding for the detection of incidental prostate carcinoma on transurethral prostate resection material: the more, the better?
T2  - Virchows Archiv
N2  - 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.
KW  - Holmium laser enucleation
KW  - HoLEP
KW  - Transurethral resection of the prostate
KW  - TUR-P
KW  - Incidental prostate cancer
KW  - Prostate cancer
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69469
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-694692
SN  - 1432-2307
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 481
IS  - 3
SP  - 387
EP  - 396
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -