Nondetected tumor (pT0) after prolonged, neoadjuvant treatment of localized prostatic carcinoma

Objectives: 135 patients with stage T1-3N0M0 prostatic carcinoma were submi tted to prolonged PSA-monitored neoadjuvant endocrine treatment (PPNET). Th e rate of pT0 reports was three times higher (15%) than after the standard 3-month therapy (5%). The present work was done to elucidate the initial ch aracteristics of these tumors, to see if additional workup of these prostat ectomy specimens is able to detect tumor vestiges and, if so, to describe t heir morphology. Methods: The original clinical and histopathological data of 20 pT0 cases w ere reviewed and an additional histopathological workup of the prostatectom y specimens was done. Results: The majority of patients had initially small (9 patients cT1, 8 pa tients cT2, 3 patients cT3) and well-differentiated tumors (18 patients Gle ason score <7). Microscopic assessment of 4,503 slides revealed very small tumor remnants (mean volume 0.2 mi) in 13 of the 20 prostatectomy specimens . Severe tumor regression was seen in 3 cases, slight to moderate regressio n in 10 cases. Conclusions: A pT0 report following detailed routine histopathological work up has to be regarded as a maximal therapeutic effect, but not as tumor eli mination. PPNET clearly increases the rate of pT0 reports, implicating that the conventional 3 months of pretreatment does not exploit the possibiliti es of neoadjuvant therapy. Copyright (C) 2000 S. Karger AG, Basel.