Elsevier

European Urology

Volume 45, Issue 1, January 2004, Pages 36-41
European Urology

Pathological T0 Prostate Cancer without Neoadjuvant Therapy: Clinical Presentation and Follow-Up

https://doi.org/10.1016/j.eururo.2003.08.001Get rights and content

Abstract

Introduction and Objectives: Radical prostatectomy is a standard therapy for patients with prostate cancer diagnosed by prostatic needle biopsy, prostate cytology, transurethral resection of the prostate or prostatectomy. In a small group of patients no tumour can be found in the radical prostatectomy specimen. These cases are classified as stage pT0. The aim of this study was to evaluate the clinical presentation of this entity and their prognosis.

Material and Methods: In a nation-wide database the clinical data of 3609 patients with prostate cancer were collected. 28 patients (0.8%) were staged as pT0 in the radical prostatectomy specimen. The data included age, prostate specific antigen (PSA), and pathological report at diagnosis, histology of the radical prostatectomy specimen and follow-up data.

Results: The diagnosis was made by TURP (transurethral resection of the prostate) in 15, prostatectomy in 2, needle biopsy in 11, and cytology in 2 patients. For patients who underwent TURP or prostatectomy the preoperative staging was T1a in 10 and T1b in 5 cases. 12 patients diagnosed by biopsy or cytology were classified T2a and one patient after biopsy as T2b. 9 patients had a GI- and 19 a GII-tumour, GIII-pattern was not represented. The mean age at diagnosis was 64.7 years (range 53–79 years). The PSA at the time of diagnosis was <4 ng/ml in 8 cases; 4–10 ng/ml in 16 cases and >10 ng/ml in 4 patients. One patient presented with a micrometastasis in a single lymph node. Median follow-up was 62 months (19–150). All patients had undetectable PSA levels following surgery. No patient presented with clinical or biochemical progression. One patient died with no evidence of disease at 133 months after radical prostatectomy.

Conclusions: None of the clinical parameters had a strong association with a pathologically proven T0 situation after radical prostatectomy in this setting. Interestingly no patient had a high-grade tumour. None of the patients classified as pT0 had a biochemical or clinical relapse during 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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