ORLANDO, FL (UroToday) - No cancer in the specimen?! How often does this happen following radical prostatectomy?

Zynger and colleagues examined a cohort of 1792 men who underwent RRP from 1/2003 to 12/2006. Trends in tumor volume over this four-year period were examined. Tumor volumes were defined as: (1) low = 0-1%, (2) intermediate = 1.1-20%, (3) high = 20.1-50% (4) very high >50%. Low tumor volumes steadily increased over time: 9.1% in 2003, 10.3% in 2004, 12.1% in 2005, and 14.0% in 2006. 74% of tumors in this cohort were of intermediate volume with high and very high tumor volumes accounting for 13.0% and 1.6%. Interestingly, the investigators report that a total of 11 patients had absolutely no tumor in the final prostatectomy specimen. All prostate biopsy specimens from these patients were re-reviewed and were confirmed indeed to have small amounts of Gleason 3+3 disease (small focus of 1 core in 10 patients, and 3 of 7 cores in 1 patient). The incidence of what the authors refer to as "vanishing cancer" grew from 0.7% in 2003 to 1.1% in 2006.

The trends reported by the authors likely reflect lower-PSA thresholds used to trigger biopsy and increasing number of cores taken at the time of biopsy.

The authors suggest that patients be counseled pre-operatively about the possibility of not seeing a tumor on final pathology.

Presented by Debra L Zynger, MD, Nikolay D Dimov, MD, William J Catalona, MD, and Ximing J Yang, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Alexander Kutikov, MD

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