Little of no residual prostate cancer at radical prostatectomy

Kumar, R.; Yadav, R.
January 2006
Indian Journal of Urology;Jan-Mar2006, Vol. 22 Issue 1, p83
Academic Journal
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 uninterpretable 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.


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