Vanishing prostate cancer on radical prostatectomy (RP) in the PSA era: incidence and follow-up data from a cohort of 1,060 patients between 1998 and 2010

Abstract

Sir: There have been a few studies investigating the incidence and prognostic relevance of the “vanishing cancer” phenomenon in the radical prostatectomy specimen (RP), in particular, in the last decade [1, 2]. We undertook this study to determine incidence and prevalence of “vanishing prostatic adenocarcinoma” at our institution and to correlate the outcome of these patients with histopathology findings. We searched our institutional database and identified a total of 18 patients with no residual cancer out of 1,060 radical prostatectomies performed between 1998 and 2010. Four patients were excluded from the analysis due to preoperative hormonal therapy (three cases) and immunotherapy (one case). In the remaining 14 cases, clinical data including age and PSA levels with biopsy data (highest Gleason score, highest percentage of carcinoma, number of biopsy sites, number of positive biopsy sites, use of immunohistochemistry, and number of previous biopsies) and RP data (number of examined slides, highest Gleason score, percentage of carcinoma, and presence of high-grade prostatic intraepithelial neoplasia) were extracted. In all 14 cases, the radical prostatectomy specimens were submitted entirely. The incidence of the vanishing cancer phenomenon was 1.3% in our series (14/1,060 RPs). Among the 14 RPs studied, residual cancer was not identified in 11 patients despite careful and extensive sampling. Three cases showed microscopic foci of cancer involving less than 0.5% of the tissue. The mean age of the patients was 59.09 (44–75). The total number of biopsy sites ranged from 2 to 14 with a mean of 7. The mean PSA was 5.8 units (3.6–9.0). The Gleason score in