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Nondetectable Prostate Carcinoma (pT0) after Radical Prostatectomy: A Narrative Review. Curr Oncol 2022; 29:1309-1315. [PMID: 35323311 PMCID: PMC8946857 DOI: 10.3390/curroncol29030111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
(1) Background: Following radical prostatectomy (RP), the absence of a demonstrable tumor on the specimen of a previously histologically proven malignancy is known as the pT0 stage. The aim of our present study is to perform a narrative review of current literature in order to determine the frequency and oncological outcomes in patients with pT0 disease. (2) Methods: A narrative review of all available literature was performed. (3) Results: The incidence of pT0 ranges between 0.07% and 1.3%. Predictors of the pT0 stage are only a single biopsy core with low-grade cancer, a cancer length not exceeding 2 mm and a high prostate volume. Biochemical recurrence ranges between 0 and 11%. (4) Conclusions: The absence of malignancy in the RP specimen despite a previous positive biopsy is a rare and unpredictable finding. Although the prognosis is considered to be excellent in most of the cases, a continued close follow-up is warranted.
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Knipper S, Tilki D, Mazzone E, Mistretta FA, Palumbo C, Pecoraro A, Tian Z, Briganti A, Saad F, Graefen M, Karakiewicz PI. Contemporary clinicopathological characteristics of pT0 prostate cancer at radical prostatectomy: A population-based study. Urol Oncol 2019; 37:696-701. [PMID: 31129038 DOI: 10.1016/j.urolonc.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/03/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The incidence of pT0 prostate cancer (CaP) at radical prostatectomy (RP) is extremely rare. We performed the first population-based analysis of pT0 CaP at RP. METHODS Within the Surveillance, Epidemiology, and End Results database (2004-2015), we tested for clinical and pathological characteristics according to pT0 vs. non-pT0 CaP and included a multivariable logistic regression model. RESULTS pT0 was identified in 358 (0.2%) out of 160,532 clinically localized RP patients. The majority of pT0 patients presented with initial prostate-specific antigen (PSA) <10 ng/ml (82.4%), harboured biopsy Gleason score (GS) 6 (69.8%) and cT1 disease (78.1%). Nonetheless, pT0 was identified in 13 (3.6%) patients with PSA ≥20 ng/ml, in 69 (19.3%) patients with biopsy GS ≥7 and in 78 (21.8%) patients with ≥cT2 disease. In a subset of patients with available number of biopsy cores, pT0 was identified in 34 (33.3%) patients with ≥2 positive biopsy cores. Age, race, marital status, hospital region, population density, PSA, as well as number of biopsy cores did not discriminate between pT0 and non-pT0 cases. Analyses according to annual rates (2004-2015) of pT0 did not vary between the years (0.2%-1.6%, estimated annual percent change: -1.6%, P = 0.3). Neither did the rates vary according to geographic region. CONCLUSIONS pT0 at RP is very rare. Even though, most pT0 patients have low PSA, low clinical stage, low biopsy GS, and only one positive biopsy core, those with more aggressive characteristics can still harbour pT0 at RP.
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Affiliation(s)
- Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco A Mistretta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Urology, University of Montréal Hospital Center, Montréal, Québec, Canada
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Urology, University of Montréal Hospital Center, Montréal, Québec, Canada
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Leal J, Welton NJ, Martin RM, Donovan J, Hamdy F, Neal D, Noble S, Lane A, Wolstenholme J. Estimating the sensitivity of a prostate cancer screening programme for different PSA cut-off levels: A UK case study. Cancer Epidemiol 2018; 52:99-105. [PMID: 29278842 DOI: 10.1016/j.canep.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/27/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Policy decisions about prostate cancer screening require data on the natural history of histological cancers and the resulting impact of screening. However, the gold standard procedure required to identify true positive histological cancer is a full autopsy of the gland which is not possible in screening studies, leading to verification bias. We aim to estimate the sensitivity of a prostate cancer screening round (PSA result to diagnosis) relative to histological cancer. METHODS We developed a framework combining data on UK screened and non-screened prostate cancer populations originating from a single round of population-based PSA testing among UK men aged 50-69 years, prostate cancer incidence data, and needle biopsy data from the published literature. RESULTS Sensitivity of a screening round was highest at age 65-69 years at 33% (95% CI: 30%-37%) and 24% (95% CI: 21%-28%) for PSA cut-off levels of 3 ng/ml and 4 ng/ml, respectively. Sensitivity was lowest at age 50-54 at 15% (95% CI: 12%-17%) and 9% (95% CI: 8%-11%) for PSA cut-off levels of 3 ng/ml and 4 ng/ml, respectively. In contrast, the clinical detection rate in the absence of mass screening, relative to histological cancer, varied between 0.2%-0.7% at age 50-54 and 1.2%-2.7% at age 65-69 from 1995 to 2012. CONCLUSIONS The framework enabled the sensitivity of a prostate cancer screening round relative to histological cancer diagnosis to be estimated and provides a basis to determine the impact and cost-effectiveness of prostate cancer screening. The approach could be adapted to inform the sensitivity of other biomarkers, cancers and screening programmes.
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Affiliation(s)
- Jose Leal
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom.
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jane Wolstenholme
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
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