No Residual Cancer on Radical Prostatectomy After Positive 10-Core Biopsy: Incidence, Biopsy Findings, and DNA Specimen Identity Analysis

Abstract

Context.—It is uncertain whether extensive prostate-specific antigen (PSA) testing and extended biopsies currently performed will increase the incidence of no residual cancer on subsequent prostatectomy. Objective.—To identify the incidence of cases with no residual cancer on prostatectomy after a positive 10-core biopsy and to review the clinical, biopsy, and prostatectomy findings and the results of specimen identity analysis. Design.—We identified 9 patients with no residual cancer in 1351 consecutive prostatectomies and we reviewed the clinical, biopsy, and prostatectomy data from our institutional database. In 6 cases encountered after 2003, we also performed a polymerase chain reaction–based microsatellite analysis on formalin-fixed tissue to confirm the identity of the biopsies and prostatectomies. Results.—All patients had positive biopsies in 1 or 2 cores: 1 in 7 and 2 in 2 patients (1 each, unilateral and bilateral). Mean total cancer length on biopsy measured 2.5 mm, which represented 1.7% of the total biopsy tissue. Gleason score 6 was found in 8 of 9 patients and 1 patient had Gleason score 9. Patients' age was 60.3 years, preoperative PSA was 6.0 ng/mL, and PSA density was 0.1 (all means). In 6 cases tested for microsatellite identity, the patient identity was confirmed. Conclusions.—Incidence of no residual cancer on prostatectomy of 0.67% after 10-core positive biopsy is higher than previously reported. In most cases, finding no residual cancer on prostatectomy after exhaustive work-up may indicate minimal patient disease. Microsatellite analysis provides a useful and cost-effective test in establishing specimen identity.

Gleason Grade Group 4 prostate biopsy with no cancer seen on final pathology in the magnetic resonance imaging and Prostate Specific Membrane Antigen‐Positron Emission Tomography era

“…The case of vanishing prostate cancer or pT0 among patients who have had prior histologically proven prostate cancer is reported at less than 2% 1 . For those individuals who have not received pre‐operative neoadjuvant hormonal therapy, the rates are reported to be lower than 1% 2 .…”

“…The case of vanishing prostate cancer or pT0 among patients who have had prior histologically proven prostate cancer is reported at less than 2%. 1 For those individuals who have not received pre‐operative neoadjuvant hormonal therapy, the rates are reported to be lower than 1%. 2 Possible explanations described in the literature include errors in the pathological review of RP or biopsy specimens, mislabeling lab error, or biopsy removing all of the prostate cancer from the organ.…”

“…Pathological T0 prostate cancer after radical prostatectomy is an uncommon and unpredictable finding. Also called vanishing prostate cancer , this phenomenon is of particular importance for patients who have not received prior hormonal therapy given the medicolegal implications 1 . Furthermore, the advent of new imaging modalities pre‐operatively may help clinicians prevent this from happening.…”

Burnt-out Metastatic Prostate Cancer

“…Vanishing prostate cancer has been reported by several authors. [15][16][17][18][19] Our case, however, did not undergo radical prostatectomy, and does not fit into the definition of vanishing prostate cancer. In addition, there have been some reports of burnt-out tumors which were found in metastatic lesions, but where the primary lesion could not be found.…”

Nondetectable Prostate Carcinoma (pT0) after Radical Prostatectomy: A Narrative Review

“…Following radical prostatectomy (RP), the absence of a demonstrable tumor on the specimen of a previously histologically proven malignancy is known as the pT0 stage. Although this is a well-known phenomenon for individuals receiving neoadjuvant hormonal therapy (NHT), the incidence of pT0 among patients who are directly treated with RP without prior androgen deprivation therapy (ADT) is <2% [1][2][3][4].…”