| TUMOUR
MAPPING IN RADICAL PROSTATECTOMY SPECIMENS USING COMPUTER
ASSISTED MICROSCOPIC ASSESSMENT OF TUMOUR VOLUME AND
EXTENT TO PREDICT OUTCOME.
Dr Catherine Corbishley St George's Hospital, Department of Cellular & Molecular Medicine |
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A number of factors are known to influence prognosis and risk of recurrence following radical prostatectomy, notably grade of tumour (Gleason score) and involvement of extraprostatic structures such as attached seminal vesicles and surrounding fat, particularly if the surgical margins are involved by tumour. There is less data on tumour volume and prognosis but several studies have shown a correlation between larger tumours and worse prognosis, independent of extent and tumour margins.
Current methods of estimating tumour volume and extent are crude and essentially involve outlining the areas of tumour with indelible pen on the glass microscope slide and measuring the area using either microscope vernier scale or a graph paper overlay. Tumour volumes are then calculated by multiplying area by slide thickness then adding volumes in each slide from the prostate to give an overall volume. The extent of positive margins is also measured by similar manual methods. These methods are time consuming and sometimes inaccurate particularly with irregularly shaped tumours.
Recently, affordable digital camera systems, integrated with modern microscopes, have developed so that tumour areas can be marked out using a visual representation of the slide and areas accurately calculated, as well as more detailed assessment of positive margin extent. These digital images can be stored and analysed using the software provided with the system to provide a permanent photographic and numerical record of the tumour extent which may also be attached to the laboratory record.
Funding from Prostate UK is requested to purchase such a modern digital microscope and imaging system together with printer, computer and software.
At St George's I have personally dissected and reported nearly 1000 radical prostatectomies since 1995 and currently see over 180 cases per year both from NHS and external practice. All the cases have been dissected using the same protocol and microscope slides have been retained in our archive and available for further study. With the advent of robotic and laparoscopic surgery it is important to compare outcomes with conventional open surgery. In addition there is little published data on those patients who have tumour extending outside the prostate or into seminal vesicles at the time of surgery, but do not have tumour at their surgical margins which we find in up to 10 % of our current cases.
I manage a pathology database of all prostate cases seen in our department since 1995 and am able to gain access to clinical and follow up data for the majority of these cases wherever their operation has been undertaken. This work will also provide useful training opportunities for both pathologists and other clinicians. I propose to undertake this project both prospectively and retrospectively for our series, which I believe to be one of the largest and best documented, single centre cohort in the UK. This will provide important data on risk of recurrence and metastasis for these patients which will influence the decision to give early or delayed post operative treatment such as radiotherapy or hormone therapy.
The funding requested is for a one off purchase of equipment, which will include a service and maintenance contract for the two year period of the study. There are no additional costs such as staffing or consumables required.
Proposal summary, 05 March 2008.
Project 2007/05