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UROSCAN
Year : 2006  |  Volume : 22  |  Issue : 1  |  Page : 83
 

Little of no residual prostate cancer at radical prostatectomy


Department of Urology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
R Kumar
Department of Urology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Kumar R, Yadav R. Little of no residual prostate cancer at radical prostatectomy. Indian J Urol 2006;22:83

How to cite this URL:
Kumar R, Yadav R. Little of no residual prostate cancer at radical prostatectomy. Indian J Urol [serial online] 2006 [cited 2020 Feb 23];22:83. Available from: http://www.indianjurol.com/text.asp?2006/22/1/83/24672

D. Cao, M. Hafez, K. Berg, K. Murphy, JI. Epstein. Little or no residual prostate cancer at radical prostatectomy: Vanishing cancer or switched specimen?: A microsatellite analysis of specimen identity. Am J Surg Pathol 2005;29:467-73.



   Summary Top


Following a needle biopsy diagnosis of prostate cancer, occasionally, no residual cancer can be identified in the radical prostatectomy specimen. Such cancers have been referred to as the 'Vanishing cancer phenomenon'. This raises the question as to whether the initial biopsy and subsequent radical prostatectomy are from the same patient. The authors used a PCR-based micro satellite marker analysis to perform identity test in 46 men, whose radical prostatectomy specimen was reported as 'minute' (n=35) or 'no residual' (n=11) cancer. DNA was isolated from formalin fixed, paraffin embedded blocks of both the biopsy and the prostatectomy specimen and PCR amplification was performed for 9 micro satellite loci. Amplification and comparison was possible in 41 of the 46 specimen. 9 of 11 patients with 'no residual cancer' matched the biopsy specimen, confirming that this report is feasible after radical prostatectomy. 1 of the 11 had un-interpretable result, while 1 did not match the biopsy, implicating a 'switched biopsy' specimen. All cases of 'minute' tumor matched the biopsy specimen. The results confirm. that in most cases of "vanishing cancer" in radical prostatectomy specimens, it reflects a chance sampling of a minute cancer and not a switch in specimens. However, if there is high-grade cancer or a lot of cancer on the biopsy and no or very minimal cancer in the radical prostatectomy specimen, one should evaluate for patient identity, as it could reflect a switched specimen. Factors responsible for "vanishing cancer" could be treatment by preoperative hormone therapy, removal of entire tumor by the biopsy needle, induction of inflammatory process resulting in resolution of the residual cancer, or inability to identify the tumor in the examined glass slides.


   Comments Top


This article, although primarily dealing with the issue of 'switched specimen', also highlights the effect of screening for prostate cancer. 'Switched specimen' may become a problem in institutions performing a large number of prostate biopsies and may not be a major problem currently in India. However, there is always a possibility that with the increasing use of 10-12 or higher cores of prostate biopsy, the entire cancer, particularly T1c disease, may be removed in the biopsy itself. If such patients were to undergo radical prostatectomy, their specimens may be reported as 'no cancer'. This would lead to medico-legal problems, if not a strain in the patient-doctor relationship. This issue of no residual disease is known to exist in bladder cancers, where transurethral resection may have removed the entire muscle-invasive disease. so that there is no tumor left in the radical cystectomy specimen.

This report will reassure both the urologist and his patient. that such a situation is not only theoretically possible. but also well documented. It also does not mean that the radical surgery was unnecessary. since minute focus does not guarantee a clinically insignificant cancer.[1]

 
   References Top

1.Bruce RG, Rankin WR, Cibull ML et al . Single focus of adenocarcinoma in the prostate biopsy specimen is not predictive of the pathologic stage of disease. Urology 1996; 48:75  Back to cited text no. 1    




 

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