Pathological T0 Prostate Cancer without Neoadjuvant Therapy: Clinical Presentation and Follow-Up
Introduction
In rare cases a radical prostatectomy for a histologically proven prostate cancer is performed without residual tumour in the prostatectomy specimen. This tumour stage is defined as pT0. A pT0 situation has been classified as a result of a neoadjuvant therapy, e.g. neoadjuvant hormone deprivation, chemotherapy, or cryotherapy [1], [2], [3], [4], [5]. A minor group of patients presents with a pT0 prostatectomy specimen after resection of larger parts of the prostate by TURP or prostatectomy revealing an incidental prostate cancer. In some cases, even by prostate needle biopsy a complete ablation of a microscopic prostate cancer is possible.
The clinical implication of a pT0 situation is unclear: Do these patients expect long-term cure? Is the prognosis depending on the tumour staging at the time of diagnosis? Since the initial staging can be clearly defined only in patients without any neoadjuvant therapy, the aim of this retrospective study was to investigate pT0 cases after radical prostatectomy in patients who had a histologically proven prostate cancer and a subsequent radical prostatectomy with pelvic lymphadenectomy without further therapy.
The main focus of this investigation was the extension of the tumour at the time of the initial diagnosis and at the time of radical prostatectomy (lymph node metastasis, other metastases), the follow-up, and the estimation of the probability for a patient with a histologically proven prostate cancer to reveal a pT0 specimen.
Section snippets
Material and methods
Informed consent of all patients was mandatory. Clinical data of 3609 patients with prostate cancer treated by radical prostatectomy since 1990 without neoadjuvant therapy were collected in a nation-wide database. Documentation included age, serum PSA level at the time of diagnosis, the histopathological report of the diagnosis (biopsy, TURP or prostatectomy), the histopathological report of the radical prostatectomy specimen and the complete follow-up data (median follow-up: 62 months)
Results
28 out of 3609 patients (0.8%) in our nation-wide database were classified as pT0 based on the radical prostatectomy specimen. The median age was 65 years (53–79 years) in pT0 patients and 64 years (37–85 years) in pT+ patients.
In 3528 out of 3609 patients (97.8%) prostate cancer was diagnosed by prostate biopsy. Only 13 of these 3528 patients (0.4%) had a pT0 radical prostatectomy specimen. In two of these cases the diagnosis was made by prostate cytology. The clinical tumour stage from DRE
Discussion
A pT0 radical prostatectomy specimen remains a rare event. Three different cases have to be distinguished.
- (a)
Patients with an incidental finding of a prostate cancer in a TURP or prostatectomy specimen without residual tumour in the radical prostatectomy specimen.
- (b)
Patients with microscopic foci of prostate cancer in needle biopsy specimens that have been completely removed by the biopsy.
- (c)
Patients with histologically proven prostate cancer who received neoadjuvant therapy before surgery.
Different
Conclusions
Radical prostatectomy without residual tumour in the prostatectomy specimen is a rare event. In patients with incidental prostate cancer (T1a/b) none of the clinical parameters provided value to predict a pT0 prostatectomy specimen, except for the exclusion of GIII tumours. Especially in immunosuppressed patients a radical prostatectomy is recommended irrespectively of the grading and Gleason score. The 10 year specific survival rate is 100% in the present study.
Acknowledgements
Supported by German Cancer Aid (70-2179-Vo I).
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