Digital versus light microscopy assessment of extraprostatic extension in radical prostatectomy samples

  • Metka Volavšek
  • Vanessa Henriques
  • Ana Blanca
  • Rodolfo Montironi
  • Liang Cheng
  • Maria R. Raspollini
  • Alessia Cimadamore
  • Nuno Vau
  • Francesco Pierconti
  • Antonio Lopez-Beltran
Original Article
Part of the following topical collections:
  1. Quality in Pathology


Focal or non-focal/extensive extraprostatic extension of prostate carcinoma is an important pathologic prognostic parameter to be reported after radical prostatectomy. Currently, there is no agreement on how to measure and what are the best cutoff points to be used in practice. We hypothesized that digital microscopy would potentially provide more objective measurements of extraprostatic extension, thus better defining its clinical significance. To further our knowledge on digital prostate pathology, we evaluated the status of extraprostatic extension in 107 consecutive laparoscopic radical prostatectomy samples, using digital and conventional light microscopy. Mean linear and radial measurements of extraprostatic extension by digital microscopy significantly correlated to pT status (p = 0.022 and p = 0.050, respectively) but only radial measurements correlated to biochemical recurrence (p = 0.042) and grade groups (p = 0.022). None of the measurements, whether conventional or digital, were associated with lymph node status. Receiving operating characteristic analysis showed a potential cutoff point to assess linear measurements by conventional (< vs. > 24.21 mm) or digital microscopy (< vs. > 15 mm) or by radial measurement (< vs. > 1.6 mm). Finally, we observed an association between the number of paraffin blocks bearing EPE with pT (p = 0.041) status (digital microscopy), and linear measurements by conventional (p = 0.044) or digital microscopy (p = 0.045) with lymph node status. Reporting EPE measurements by digital microscopy, both linear and radial, and the number of paraffin blocks with EPE, might provide additional prognostic features after radical prostatectomy.


Prostate cancer Radical prostatectomy Extraprostatic extension Digital microscopy Digital pathology Biochemical recurrence 


Authors’ contributions

ALB, MV, and VH conceived and designed the study and wrote, edited, and reviewed the manuscript. AB performed the statistical analysis and reviewed the manuscript. AC, MRR, NV, VH, FP, and ALB collected and analyzed data and reviewed the manuscript. RM and LC critically read and edited the final manuscript. All authors gave final approval for publication.

Compliance with ethical standards

Competing interests

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was obtained from all patients included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Pathology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
  2. 2.Pathology ServiceChampalimaud Clinical CenterLisbonPortugal
  3. 3.Maimonides Biomedical Research Institute of CordobaCordobaSpain
  4. 4.Institute of Pathological Anatomy and Histopathology, School of MedicinePolytechnic University of the Marche Region (Ancona), United HospitalsAnconaItaly
  5. 5.Departments of Pathology and Laboratory Medicine and Urology, School of MedicineIndiana UniversityIndianapolisUSA
  6. 6.Histopathology and Molecular DiagnosticsUniversity Hospital CareggiFlorenceItaly
  7. 7.Urologic OncologyChampalimaud Clinical CenterLisbonPortugal
  8. 8.Division of Anatomic Pathology and HistologyCatholic University of the Sacred Heart, “Agostino Gemelli” School of MedicineRomeItaly
  9. 9.Department of Pathology, Unit of Anatomical Pathology, Department of Surgery, Faculty of Medicine, CordobaSpain and Champalimaud Clinical CenterLisbonPortugal
  10. 10.CordobaSpain

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