Nondetected Tumor (pT0) after Prolonged, Neoadjuvant Treatment of Localized Prostatic Carcinoma

Köllermann, Jens; Feek, U.; Müller, Heimo; Kaulfuss, U.; Oehler, U; Helpap, B.; Köllermann, M. W.

doi:10.1159/000020367

Cited by 34 publications

(11 citation statements)

References 29 publications

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“…In contrast, patients with a biopsy positive for cancer, but with no cancer in the radical prostatectomy specimen, have no increased risk of tumor recurrence or progression. 50,[56][57][58][59] European urologists have suggested that in these cases, pT2 could be further characterized as pT2(À), where (À) indicates that cancer was not detected in the surgical specimen. Another alternative is to grade these tumors as pT2 ( þ bx/Àrp) to indicate the special situation of a positive biopsy ( þ bx) with no cancer detected in the radical prostatectomy specimen (Àrp).…”

Section: Radical Prostatectomy Specimens With No Carcinoma On Initialmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling

Samaratunga¹,

et al. 2011

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The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the handling and processing of radical prostatectomy specimens were coordinated by working group 1. Most uropathologists followed similar procedures for fixation of radical prostatectomy specimens, with 51% of respondents transporting tissue in formalin. There was also consensus that the prostate weight without the seminal vesicles should be recorded. There was consensus that the surface of the prostate should be painted. It was agreed that both the prostate apex and base should be examined by the cone method with sagittal sectioning of the tissue sample. There was consensus that the gland should be fully fixed before sectioning. Both partial and complete embedding of prostates was considered to be acceptable as long as the method of partial embedding is stated. No consensus was determined regarding the necessity of weighing and measuring the length of the seminal vesicles, the preparation of whole mounts rather than standardized blocks and the methodology for sampling of fresh tissue for research purposes, and it was agreed that these should be left to the discretion of the working pathologist.

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Section: Radical Prostatectomy Specimens With No Carcinoma On Initialmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling

Samaratunga¹,

et al. 2011

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“…No residual cancer may also result from preoperative endocrine therapy [11, 12, 15, 16, 19, 24, 26]. The incidence of pT0 after neoadjuvant endocrine therapy for prostate cancer is reported to be higher than in untreated patients [11].…”

Section: Introductionmentioning

confidence: 99%

Search for residual prostate cancer on pT0 radical prostatectomy after positive biopsy

et al. 2007

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Reported incidence of no residual prostate cancer (i.e. pathological stage pT0) on radical prostatectomy ranges from 0.07 to 4.2%. The incidence is higher after neoadjuvant endocrine treatment. The aim of this study was to search for residual cancer on radical prostatectomy (RP) specimens when an initial sampling failed to find the cancer in patients with positive biopsy. Our database of 1,328 consecutive patients whose biopsies and RP specimen were both examined at the Polytechnic University-United Hospitals of the Marche Region between March 1995 and June 2006 was reviewed. The radical prostatectomies were grossly completely sampled and examined with the whole mount technique. We identified eight patients (i.e. 0.6%; three untreated and five hormonally treated preoperatively, i.e. 0.3 and 0.8%, respectively, of the total number of RPs included in the study) with positive biopsy and with no residual cancer in the initial routine histological examination of the RP. The RP of this group of eight was subjected to additional sectioning and evaluation of the paraffin blocks of the prostatectomy, also after block-flipping, immunostaining with an antibody against CAM 5.2, p63, PSA, and alpha-methylacyl-CoA racemase, and DNA specimen identity analysis. There were no cases with a false positive biopsy diagnosis, and cancer was not overlooked or missed in the initial routine histological examination of any of the 8 pT0 RPs. A minute focus of cancer (the diameter was always below 2.0 mm) was found on the additional sections in five. In particular, cancer was found after block-flipping in one of them. In an additional case, cancer was eventually discovered after immunostaining tissue sections for cytokeratin CAM 5.2, for p63 and PSA. In the remaining two cases (one untreated and the other hormonally treated), cancer was not found (0.15% of the 1,328 RPs included in the study); the review of the description of the macroscopic appearance of the RP and of its slides revealed that part of the peripheral zone corresponding to the site of the positive biopsy was missing, i.e. not removed from the patient at the time of the operation at least in one of the two. DNA specimen analysis confirmed the identity of the biopsy and prostatectomy in both. An extensive search for residual cancer reduces the number of pT0 RPs after a positive biopsy from 0.6 to 0.15%. It is recommended to have the needle biopsy reviewed, carefully look again at the radical prostatectomy, do deeper sections and then flip certain paraffin blocks. In addition, atypical foci should be stained for basal cell markers and often AMACR, especially in hormone-treated cases. If a block is missing part of the peripheral zone (capsular incision), this should be commented on. DNA analysis for tissue identity should be performed when the other steps have been taken without finding cancer.

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“…Staging lymphadenectomy of the obturator lymph nodes was carried out routinely, and when frozen section examination of the lymph nodes revealed metastasis, RP was abandoned (n = 7), thus RP was completed in 1351 men. A further 34 patients were excluded from the study because of neoadjuvant hormonal treatment which may have resulted in molecular regression of the PC and compromised pathological staging [7]. Overall, 1317 patients were eligible for evaluation.…”

Section: Study Populationmentioning

confidence: 99%

Shift of tumor features in patients with clinically localized prostate cancer undergoing radical prostatectomy since the beginning of the PSA era

Augustin

Auprich

Stummvoll

et al. 2006

Wien Klin Wochenschr

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Nondetected Tumor (pT0) after Prolonged, Neoadjuvant Treatment of Localized Prostatic Carcinoma

Cited by 34 publications

References 29 publications

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling

Search for residual prostate cancer on pT0 radical prostatectomy after positive biopsy

Shift of tumor features in patients with clinically localized prostate cancer undergoing radical prostatectomy since the beginning of the PSA era

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