Prostate Surgery Evaluation

Prostate cancer continues to be the leading cancer in the United States male population. Surgical removal remains the standard procedure for cure. Within the surgical arena, various approaches for surgical extirpation have been employed. Currently there are little objective parameters that are used to compare the efficiency of each form of surgical removal. As surgeons apply these different surgical approaches, a quality assessment would be most useful, not only with regard to overall comparison of one approach vs. another but also with regard to a surgeon’s evaluation of personal surgical performance as they relate to a standard.

 This research involves the development of a process employing image reconstruction and analysis techniques to assess the volume and extent of extracapsular soft tissue removed with the prostate by each of the various surgical approaches. Parameters such as the percent of capsule covered by soft tissue and where present the average depth of soft tissue coverage is assessed. Below is a scanned image of a pathologically processed prostate slice showing the boundary of the prostate gland capsule in yellow.

Figure 1: A prostate slice with the hand-drawn capsule boundary

  The research is performed at Old Dominion University (ODU) and the Virginia Prostate Center (VPC) at Eastern Virginia Medical School (EVMS).  Using preliminary (non-whole mount) data, ODU has investigated methodologies that can be used to achieve statistically relevant results. EVMS, to date, has provided preliminary data in the form of images from archived specimens. Additionally, EVMS has obtained the necessary IRB approvals and has provided several whole-mount prostate slices obtained from newly excised specimens. Figure 2 is an example showing 3D reconstruction from these prostate slices.  

Figure 2: Reconstructed 3D Model Showing Extracapsular Soft Tissue

A final goal is to develop software for the purpose of a quality assessment for pathologists and surgeons to evaluate the adequacy/appropriateness of each surgical procedure; laparoscopic versus open perineal or retropubic prostatectomy. This goal will be accomplished by evaluating readily available measurements. Figure 3 compares the fresh specimen with a 3D model showing the bright red regions bare of extracapsular tissue.

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            Figure 3:  Fresh prostate specimen (a) and reconstructed prostate model (b)

In addition, software algorithms are being developed to perform automatic recognition of the various determinant parameters and measurements leading to the final assessment of quality assurance. These algorithms would include automatic recognition of the prostate capsule and outer parenchymal contour.  Currently, this is tediously done by pathologists in order to facilitate 3D reconstruction of the prostate capsule and extra-capsular tissue.

Figure 4: Prostate slice showing parenchymal contour in yellow with prostate boundary in dashed black