Incidental Carcinoma of the Prostate at the Time of Transurethral Resection: Importance of Evaluating Every Chip

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Abstract
Incidental adenocarcinoma of the [human] prostate has been divided into stage A1, less than 3 foci of well differentiated adenocarcinoma present, and stage A2, 3 or more foci or poorly differentiated tumor present. The clinical significance of these 2 stages is well documented: stage A1 lesions cause no increased mortality, while up to 30% of patients with clinical stage A2 disease will have positive pelvic lymph nodes at exploration and surgical stage D1 tumor. Most pathology laboratories submit only a fraction of the transurethral resection chips for permanent blocks. To evaluate the over-all incidence and distribution of stages A1 and A2 lesions a prospective study was begun in 1978 whereby all prostatic chips were submitted for permanent sections. A review of 500 consecutive cases of transurethral resection for clinically benign prostates before 1978 revealed 43 cases of adenocarcinoma: 10 (23%) stage A1 and 33 (77%) stage A2. A review of a similar series of 500 consecutive patients since 1978 revealed 71 cases of adenocarcinoma: 17 (24%) clinical stage A1 and 54 (76%) clinical stage A2. Since 1978 incidental adenocarcinoma of the prostate has increased by 65% and the distribution of stages A1 and A2 lesions has remained unchanged, 76% of these lesions being clinical stage A2 with its much greater clinical significance. Evaluation of every chip does make a clinically significant difference in the subsequent management of patients with incidental adenocarcinoma of the prostate.