Radical Prostatectomy Pathology Reporting

Measure Specification

Therapeutic decisions for prostate cancer management are stage driven and cannot be made without a complete set of pathology descriptors. Incomplete pathology reports for prostate cancer may result in misclassification of patients, rework and delays, and suboptimal management. The College of American Pathologists Cancer Committee has produced an evidence-based protocol/checklist of essential pathologic parameters that are recommended to be included in prostate cancer resection pathology reports.

Conformance of pathology reports with the CAP checklist is a requirement for Cancer Center certification by the ACS. The protocol recommends the use of the TNM Staging System for carcinoma of the prostate of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC). The radical prostatectomy checklist also includes extraprostatic extension.

In a study of cancer recurrence following radical prostatectomy, it was noted that “The relatively high proportion of patients who have biopsy-proven local recurrence who have organ-confined disease is probably inaccurate and, in large part, reflects under sampling and under recognition of extraprostatic extension” (Ripple et al 2000 Mod Path). The CAP Q probes data indicate that 11.

6% of prostate pathology reports had missing elements. Extent of invasion (pTNM) was most frequently missing (52.1% of the reports missing elements), and extraprostatic extension was the second most frequently missing (41.7% of the reports missing elements). Margin status was missing in 8.3% of reports. A sampling from prostate cancer cases in 2000 through 2001 from the College of Surgeons National Cancer Data Base found only 48.

2% of surgical pathology reports for prostate cancer documented pathologic stage similar to the more recent data from the CAP Q probes study. The NCDB data showed the Gleason score was present 86.3% of the time, slightly less than the 100% compliance found in the CAP Q probes study and that margin status was present in 84.9% of reports.

Patient management and treatment guidelines promote an organized approach to providing quality care. The (American College of Surgeons Committee on Cancer) CoC requires that 90% of pathology reports that include a cancer diagnosis contain the scientifically validated data elements outlined in the surgical case summary checklist of the College of American Pathologists (CAP) publication Reporting on Cancer Specimens.

The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.

Pathologic staging is usually performed after surgical resection of the primary tumor. Pathologic staging depends on pathologic documentation of the anatomic extent of disease, whether or not the primary tumor has been completely removed. CAP September 2023 Protocol for the Examination of Radical Prostatectomy Specimens From Patients With Carcinoma of the Prostate Gland REFERENCES: Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP.

The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017 Mar;67(2):93-99. doi: 10.3322/caac.21388. Epub 2017 Jan 17. PMID: 28094848. Gladell P. Paner, MD, FCAP; John R. Srigley, MD; Lara R. Harik, MD, FCAP; et al. (2023) Protocol for the Examination of Radical Prostatectomy Specimens From Patients With Carcinoma of the Prostate Gland Prostate_4.

3.0.0.REL_CAPCP.pdf Ripple, M., Potter, S., Partin, A. et al. Needle Biopsy of Recurrent Adenocarcinoma of the Prostate After Radical Prostatectomy. Mod Pathol 13, 521–527 (2000). https://doi.org/10.1038/modpathol.3880091 COPYRIGHT: The measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

The measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the measure for commercial gain, or incorporation of the measure into a product or service that is sold, licensed or distributed for commercial gain.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. © 2025 College of American Pathologists. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The College of American Pathologists disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

CPT® contained in the Measures specifications is copyright 2004-2025 American Medical Association. ICD-10 is copyright 2025 World Health Organization. All rights reserved. 2026 Clinical Quality Measure Flow Narrative for Quality ID #250: Radical Prostatectomy Pathology Reporting Disclaimer: Refer to the measure specification for specific coding and instructions to submit this measure.

1. Start with Denominator 2. Check Diagnosis for malignant neoplasm of prostate as listed in Denominator*: a. If Diagnosis for malignant neoplasm of prostate as listed in Denominator* equals No, do not include in Eligible Population/Denominator. Stop processing. b. If Diagnosis for malignant neoplasm of prostate as listed in Denominator* equals Yes, proceed to check Patient procedure during the performance period as listed in Denominator*.

3. Check Patient procedure during the performance period as listed in Denominator*: a. If Patient procedure during the performance period as listed in Denominator* equals No, do not include in Eligible Population/Denominator. Stop processing. b. If Patient procedure during the performance period as listed in Denominator* equals Yes, proceed to check Specimen site other than anatomic location of prostate.

4. Check Specimen site other than anatomic location of prostate: a. If Specimen site other than anatomic location of prostate equals Yes, do not include in Eligible Population/Denominator. Stop processing. b. If Specimen site other than anatomic location of prostate equals No, include in Eligible Population/Denominator. 5. Denominator Population: • Denominator Population is all Eligible Procedures in the Denominator.

Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 80 procedures in the Sample Calculation. 6. Start Numerator 7. Check Pathology report includes pT category, pN category, Gleason score and statement about margin status: a. If Pathology report includes pT category, pN category, Gleason score and statement about margin status equals Yes, include in Data Completeness Met and Performance Met.

• Data Completeness Met and Performance Met letter is represented in the Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter a equals 40 procedures in Sample Calculation. b. If Pathology report includes pT category, pN category, Gleason score and statement about margin status equals No, proceed to check Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report.

8. Check Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report: a. If Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report equals Yes, include in Data Completeness Met and Denominator Exception.

• Data Completeness Met and Denominator Exception letter is represented in the Data Completeness and Performance Rate in the Sample Calculation listed at the end of this document. Letter b equals 10 procedures in the Sample Calculation. b. If Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report equals No, proceed to check pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified.

9. Check pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified: a. If pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified equals Yes, include in the Data Completeness Met and Performance Not Met.

• Data Completeness Met and Performance Not Met letter is represented in the Data Completeness in the Sample Calculation listed at the end of this document. Letter c equals 20 procedures in the Sample Calculation. b. If pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified equals No, proceed to check Data Completeness Not Met.

10. Check Data Completeness Not Met: • If Data Completeness Not Met, the Quality Data Code or equivalent was not submitted. 10 procedures have been subtracted from Data Completeness Numerator in the Sample Calculation. Sample Calculations Data Completeness equals Performance Met (a equals 40 procedures) plus Denominator Exception (b equals 10 procedures) plus Performance Not Met (c equals 20 procedures) divided by Eligible Population/Denominator (d equals 80 procedures).

All equals 70 procedures divided by 80 procedures. All equals 87.5 percent. Performance Rate equals Performance Met (a equals 40 procedures) divided by Data Completeness Numerator (70 procedures) minus Denominator Exception (b equals 10 procedures). All equals 40 procedures divided by 60 procedures. All equals 66.67 percent. *See the posted measure specification for specific coding and instructions to submit this measure.

NOTE: Submission Frequency: Procedure The measure diagrams were developed by CMS as a supplemental resource to be used in conjunction with the measure specifications. They should not be used alone or as a substitution for the measure specification.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. The most advantageous quality data code (QDC) submitted will be used for performance.