Person with cancer—extraprostatic extension indicator, present/indeterminate/not identified code N

Identifying and definitional attributes

• Health, Standard 14/05/2015

Value domain attributes

Representational attributes

Source and reference attributes

Data element attributes

Collection and usage attributes

Record the presence of extraprostatic extension (EPE) in a person with prostate cancer. This item should be completed both after diagnostic testing/imaging is completed and after surgery.

Record "present" where EPE is clearly present, record "indeterminate" where it is unclear if EPE is present, and record "not identified" when there is no indication of EPE. Further details regarding this can be found in the RCPA Prostate cancer (radical prostatectomy) structured reporting protocol.

The assessment of EPE can be difficult, as the prostate is not surrounded by a discrete, well defined fibrous capsule. Adding to the difficulty, there is often a fibrotic reaction in the vicinity of EPE, and the neoplastic extraprostatic glands are often seen in fibrous tissue, not fat.

Therefore, EPE can be identified in several different situations and can be diagnosed by one of the following:

• The presence of neoplastic glands abutting or within periprostatic fat (most useful at the lateral, posterolateral and posterior aspects of the gland).
• Neoplastic glands surrounding nerves in the neurovascular bundle (posterolaterally).
• The presence of a nodular extension of tumour beyond the periphery of the prostate. This latter situation is best identified at low power magnification. In this assessment, the edge of the prostate is defined as the plane between fat and the condensed fibromuscular prostatic stroma which is best initially determined in a region without distortion by tumour.

Tracking along the edge of the prostate at low power, EPE is present when there is bulging of the tumour beyond the normal rounded contour of the prostate gland.

Source and reference attributes

Royal College of Pathologists of Australasia 2014. Prostate cancer (radical prostatectomy) structured reporting protocol 2nd edition. RCPA, Sydney. Viewed 21 December 2014, http://www.rcpa.edu.au/getattachment/f506078a-3bd4-4a1c-8b8c-85d2f2dfcf61/Protocol-prostate-cancer-radical-prostatectomy.aspx

Relational attributes