Removal of the prostate (radical prostatectomy) (PG057)

Pathomorphological examination during radical prostatectomy — is a comprehensive analysis of the entire prostate gland along with the capsule, seminal vesicles, and fragments of the vas deferens removed during surgery. The study code PG057 is the "gold standard" of definitive diagnosis, allowing for comprehensive information about the prevalence and nature of the tumor, which was previously assessed only through biopsy.

Research objective: The main task is accurate postoperative staging of cancer ($pTNM$) and assessment of the radicality of the operation. The pathologist carefully examines the entire organ to determine whether tumor cells remain in the body and whether there is a need for further radiation or hormonal therapy.

What does the pathologist evaluate:

• Final Gleason score: determining the degree of aggressiveness of the cancer based on the study of the entire volume of the gland (may differ from the results of a previous biopsy).

• Surgical margin status ($R0$ or $R1$): checking the margins of the section for the presence of cancer cells. "Clean" margin ($R0$) indicates complete removal of the tumor.

• Extraprostatic spread: detection of tumor invasion beyond the prostate capsule into the surrounding fatty tissue.

• Invasion of the seminal vesicles: checking whether the tumor has spread to neighboring organs (a critical factor for prognosis).

• Lymphovascular and perineural invasion: assessment of the spread of cancer along blood vessels and nerve fibers.

• Lymph node status (if submitted): search for micrometastases in removed regional lymph nodes.

Clinical significance: The conclusion with the code PG057 is the basis for further management of the patient. If the tumor is confined to the organ and the resection margins are clean, the patient moves to the stage of monitoring the PSA level. If capsule germination or a positive surgical margin is detected, the oncologist considers the issue of adjuvant (additional) therapy to prevent recurrence.

When is it prescribed:

• after radical prostatectomy (open, laparoscopic or robot-assisted);

• in the treatment of localized and locally advanced prostate cancer;

• as a stage of combination treatment at high risk of disease progression.