Prostate
Prostatic carcinoma
Vanishing cancer phenomenon

Author: Kenneth Iczkowski, M.D. (see Authors page)

Revised: 8 August 2016, last major update March 2015

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Vanishing cancer [title]
Cite this page: Vanishing cancer phenomenon. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostatevanishing.html. Accessed December 9th, 2016.
Definition / General
Epidemiology
Etiology
  • Most often, the phenomenon is attributed to the fact that routine histologic sections cannot evaluate every cubic millimeter of prostate volume, so small cancer foci remain in the wax
  • Rarely, prostate cancer may have been ablated by the biopsy or transurethral resection procedure (BJU Int 2004;94:939)
  • It is also proposed that a minute cancer focus at the edge of the prostate may be inadvertently left behind in the overzealous attempt to perform a nerve sparing procedure (Indian J Cancer 2013;50:170)
Diagnosis
  • Diagnostic resolution should include these steps, in the following order:
    • If the prostatectomy tissue has been partially submitted, complete submission should be pursued
    • Get a second pathologist, particularly a urologic pathologist, to re-read the slides
    • Review the biopsy that was diagnostic of cancer, if slides are available (Micro image 1)
    • Order either prostate basal cell markers (p63 or CK903) or P504S racemase immunostains or deeper levels, or both on areas initially suspicious for cancer (ASAP) (Micro image 2)
    • Flip tissue in some or all of the paraffin blocks and have the opposite surfaces of the tissues cut
    • DNA identity analysis can be performed if specimen switching is suspected (see below)
Gross Images

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Paraffin blocks before and after block flipping

Micro Images

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Small groups of atypical acini

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CAM 5.2

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Whole mount

Molecular / Cytogenetics Description
  • Microsatellite analysis can be performed on the prostatectomy and biopsy specimens to confirm specimen identity
  • This is particularly indicated if there is high grade or high-volume cancer on the biopsy (Am J Surg Pathol 2005;29:467)