AUCTORES
Review Article
*Corresponding Author: Anthony Kodzo-Grey Venyo, North Manchester General Hospital, Department of Urology, Delaunays Road, Manchester, M8 5RB, United Kingdom.
Citation: Grey Venyo AK, (2024), Varnishing prostate cancer acinar (adenocarcinoma of the prostate gland pt0) in prostate biopsy specimen which subsequently becomes diagnosed as no prostate cancer or pt0 prostate cancer in a prostatectomy specimen: review and update, Journal of Clinical Surgery and Research, 5(2); DOI:10.31579/2768-2757/109
Copyright: © 2024, Anthony Kodzo-Grey Venyo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 04 January 2024 | Accepted: 31 January 2024 | Published: 19 February 2024
Keywords: varnishing prostate cancer; adenocarcinoma of prostate; pt0; prostate biopsy; histopathology; immunohistochemistry; prostatectomy; recurrence; no tumour
Taking into consideration the increased undertaking of screening tests for serum prostate-specific antigen (PSA), it would be envisaged that the diagnosis of prostate cancer at an early clinical stage and small tumour-size had been appreciably increased over recent years and as a consequence, the volume of tumour within radical prostatectomy (RP) specimens had decreased in size. Pathological stage pT0 is referred to as no evidence of residual tumour within a radical prostatectomy (RP) specimen from a patient in whom biopsy-proven prostate carcinoma had been histologically confirmed as a diagnosis. This entity was given a terminology of the "vanishing cancer phenomenon" by Goldstein and associates. The pT0 stage of prostate cancer had been noted ensuing hormone therapy or prior transurethral resection of the prostate (TURP) for benign prostatic hyperplasia before the undertaking of RP. Even though much research had addressed these two scenarios of pT0 stage prostate cancer, patients that manifest with pT0 status in cases other than the aforementioned two scenarios occur on very rare occasions which had been iterated to be in between 0.2% and 0.8% of all prostate cancer patients). Only few studies had examined such patients. The clinical significance of pT0 staging has remained not to be clear. Nevertheless, many reports had documented that that pT0 stage patients do portend a highly satisfactory clinical outcome. pT0 at RP is extremely rare. Although most pT0 patients had tended to have low serum PSA levels, low clinical stage, low biopsy Gleasson Score (GS), and only one positive biopsy core, those with more aggressive characteristics could still harbour pT0 at RP. In order to prevent the undertaking of unnecessary treatment of such clinically insignificant cancers, it would be important to ascertain preoperative clinical and pathologic characteristics which might help the Urologists and oncologist to pre-operatively ascertain patients with a high probability of pT0 staging upon RP specimens. The ensuing article has discussed general overview aspects as well as miscellaneous narrations and discussions from some case reports, case series and studies related to the varnishing prostate cancer in order to provide recent educative material on the varnishing prostate cancer to all readers.
It has been iterated that carcinoma of prostate gland (prostate cancer) is the commonest malignancy which afflicts males within the western world, and that adenocarcinoma of prostate gland had often tended to be treated by the undertaking of radical prostatectomy (RP). [1] It had furthermore been iterated that with regard to rare cases of primary adenocarcinoma of prostate gland, no demonstrable cancer had been found within the radical prostatectomy (RP) specimen upon thorough pathology examination despite previous pathology examination features which had confirmed positive biopsy of prostate features of adenocarcinoma of prostate gland. It had been iterated in a number of published documentations that the incidence of pT0 disease or “vanishing cancer” or the finding of no evidence of prostate cancer upon subsequent examination of radical prostatectomy specimens examined pursuant to treatment of the prostate cancer as treatment of curative intent is very low and that the prevalence rates had ranged from 0.2% to 0.8% [1] [2], [3], [4] It has also been documented that varnishing prostate cancer had been associated with neoadjuvant hormonal therapy, but varnishing prostate cancer may also occur outside of this setting [1] [4]. The finding of no evidence of prostate cancer or absence of prostate cancer within a radical prostatectomy specimen might represent a challenging situation as an enigma to both, the patient and the Urologist. Despite the rarity of the varnishing prostate cancer, considering that occasional cases of the varnishing prostate had been reported on sporadic occasions, it is important for the Urologist to ascertain, factors that may emanate in or be associated with the finding of the varnishing prostate cancer or the future finding of no evidence of prostate cancer as well as what needs to be done under such scenarios. The ensuing article on the Varnishing prostate cancer has been divided into two parts: [A] Overview of the varnishing adenocarcinoma of prostate cancer and [B] Miscellaneous narrations and discussions related to some case reports, case series, and studies related to the varnishing acinar adenocarcinoma of prostate gland.
Aim
To review and update the literature on the varnishing adenocarcinoma of prostate gland.
Methods
Internet data bases were searched including: Google; Google Scholar; Yahoo; and PUBMED. The search words that were used included: the varnishing prostate cancer; the varnishing acinar adenocarcinoma of prostate gland; no evidence of prostate cancer in radical prostatectomy specimens following a previous positive prostate cancer confirmation in a prior prostate biopsy specimen. Forty-one (41) references were identified which was used to write the ensuing article which has been divided into two parts: [A] Overview of the varnishing adenocarcinoma of prostate cancer and [B] Miscellaneous narrations and discussions related to some case reports, case series, and studies related to the varnishing acinar adenocarcinoma of prostate gland.
[A] Overview
Definition / general statements [5]
Essential features
The essential features of acinar ductal adenocarcinoma of the prostate gland that is referred to as the varnishing prostate cancer had been summated as follows:[5]
Epidemiology
The epidemiology of the varnishing prostate cancer acinar adenocarcinoma of the prostate gland has been summated as follows: [5]
Aetiology [5]
Diagnosis [5]
Laboratory [5]
Gross description [5]
Positive stains [5]
[B] Miscellaneous Narrations and Discussions from Some Case Reports, Case Series and Studies Related to The Varnishing Prostate Cancer
Goldstein et al. [6] stated the following:
Goldstein et al. [6] evaluated the clinical and pathology examination findings in 13 such cases in an effort to document this finding, which they had referred to as the "vanishing cancer phenomenon." Goldstein et al. [6] reported that the mean number of prostate-slides they had examined per case was 79 and the number of prostate-slides they had examined had ranged from 34 slides to 248. Goldstein et al. [6] summarised their results as follows:
Knipper et al. [7] made the ensuing conclusions:
Korarac et al. [8] made the ensuing conclusions:
Mazzucchelli et al. [9] undertook a study, to search for residual cancer on radical prostatectomy (RP) specimens when an initial sampling had failed to find the cancer in patients who had tumour positive biopsy. Mazzucchelli et al. [9] reported that they had reviewed their database of 1,328 consecutive patients whose biopsies and RP specimen were both examined at the Polytechnic University-United Hospitals of the Marche Region between March 1995 and June 2006. Mazzucchelli et al. [9] also reported that the radical prostatectomies were grossly completely sampled and examined with the whole mount technique. Mazzucchelli et al. [9] summated the results as follows:
Mazzucchelli et al. [9] made the ensuing additional conclusions and recommendations:
Duffield et al. [10] iterated that radical prostatectomy (RP) specimens occasionally contain no carcinoma within the initial slides of an entirely submitted specimen, but no protocol had been established to assess for carcinoma in the remainder of the specimen. Duffield et al. [10] evaluated 34 cases with no carcinoma in the initial slide review of the entirely submitted RP over a 2-year interval out of 2200 RPs. Duffield et al. [10] reported that their sequential protocol for cases with no initial tumour included the following: (1) to review the biopsy; (2) to undertake immunohistochemistry staining on suspicious foci; (3) to perform levels on blocks with high-grade prostatic intraepithelial neoplasia; (4) to perform 3 levels on the posterior sextant and adjacent sextant region where cancer was identified on biopsy; and (5) to flip the blocks within these regions and to perform 3 additional levels. Duffield et al. [10] summarised the results as follows:
Javali et al. [11] iterated the following:
Javali et al. [11] made the ensuing conclusions:
Preisser et al. [13] stated the following:
Two recent European studies had demonstrated an increasing proportion of non-organ-confined (NOC; pathologic stages T3-4) prostate cancer (PCa) in radical prostatectomy (RP) specimens. Preisser et al. [13] undertook a study, to ascertain if the trend for NOC and pT3-4 PCa is also evident among contemporary North American patients. With regard to the design, setting, and participants. Preisser et al. [13]: reported the following: Within the Surveillance, Epidemiology, and End Results database (2010-2014), they had identified 58 558 patients with clinically localized PCa which had been treated with RP. Preisser et al. [13] included only patients with clinical stage T1-2 and biopsy Gleason grade group (GGG) 1-3 prostate cancer (PCa). Preisser et al. [13] iterated the following:
Iczkowski et al. [15] stated that they had performed the first evaluation of the effects of the 5-alpha-reductase inhibitor class of drugs on cancer histopathologic features at radical prostatectomy in a placebo-controlled multi-centre trial. Iczkowski et al. [15] analysed prostatectomy slides in a blinded manner from 17 men who had been treated with dutasteride, an inhibitor of types 1 and 2 isoenzymes of 5-alpha-reductase, and 18 men who had been treated with placebo for 5 to 11 weeks before undergoing radical prostatectomy. The histopathology examination features of benign epithelium, high-grade prostatic intraepithelial neoplasia, and cancer were recorded, and the treatment effect was also scored. Digital imaging analysis was utilised to measure the stroma/epithelium ratio and epithelial height, as well as the nuclear area in cancer. Iczkowski et al. [15] summated the results as follows:
Montgomery et al. [16] stated the following:
Kalampokis et al. [17] stated that following the undertaking of radical prostatectomy (RP), the absence of a demonstrable tumour on the specimen of a previously histologically proven malignancy is known as the pT0 stage. Kalampokis et al. [17 undertook a study to perform a narrative review of current literature in order to ascertain the frequency and oncology outcomes in patients with pT0 disease. Kalampokis et al. [17] undertook a narrative review of all available literature. Kalampokis et al. [17] summated the results as follows:
Osunkoya et al. [17] iterated that one would expect cases with small foci of cancer at radical prostatectomy to be associated with correspondingly favourable (Gleason score < or>
– Nil
Acknowledgements to: The Korean Journal of Urology for granting permission for reproduction of figures and contents of their Journal article under copyright: Copyright © The Korean Urological Association, 2010
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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