BERKELEY, CA (UroToday.com) - For a urologist who has practiced a sufficient number of years, this unsettling clinical scenario may have been encountered. The pT0 stage for prostate cancer describes that no malignancy can be identified in a radical prostatectomy specimen. This raises the questions of where the cancer went, was there really cancer there to begin with, and a myriad of other unsettling concerns from the patient, the urologist, and the pathologist.
In this study we looked at our experience with the pT0 stage of prostate cancer over a 20-year period at a U.S. Midwest tertiary care academic medical center. Excluding those who underwent neoadjuvant therapy, we found only four cases in over 1 600 prostatectomies from our institution. Upon re-review of biopsy and radical prostatectomy slides, we did find small foci of cancer in two of the four pT0 cases; thus our overall incidence of pT0 was only 0.1%—lower than the 0.4% cited in a recent systematic review. All four cases had biopsy-proven malignancy that was low grade (Gleason 3+3), low volume (less than 1% or measured < 1 mm of a single biopsy core), clinical T1c disease with PSA < 7.5 ng/ml. When compared to other cited studies, these criteria make up a stricter threshold that, above which, pT0 was not encountered.
An interesting follow-up study would be to look at all cases that fell below these threshold pre-prostatectomy criteria and characterize the final pathologic staging in order to achieve a more meaningful estimate of pT0 likelihood of those with low-risk disease. Unfortunately, our available data for this retrospective review did not allow for this comparison.
Only during the latter part of the study period did active surveillance of low-risk prostate cancers rise in popularity. As the impetus for prostatectomy wanes in these low-risk, low-volume patients, will the pT0 stage become even more rare? Regardless of its rarity, it remains an unsettling clinical scenario for all involved and thus deserves some attention.
Matthew J. Bream and James A. Brown as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, University of Iowa, Iowa City, Iowa USA