Men older than 70 years had higher risk disease and poorer survival in the early and late prostate specific antigen eras. Pathological Gleason sums did not change between the 2 eras. Patient age was an important variable in prostate specific antigen screening, biopsy, treatment and prognosis.

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Objective To compare the effects of tumor volume (TV), tumor percentage involvement (TPI) and prostate volume (PV) on PSA recurrence (PSAR) following radical prostatectomy (RP). Methods A cohort of 3528 patients receiving RP between 1988 and 2008 was retrieved from the Duke Prostate Center. Patients were stratified by TV (<3cc, 3-6cc, >6cc), TPI (<10%, 10-20%, >20%) and PV (<35cc, 35-45cc, >45cc) and their effects on PSAR evaluated using Kaplan-Meier (KM) analysis. Clinico-pathological variables included in univariate analysis were age at surgery, race, year of surgery, PSA, pathological Gleason score, pathological tumor stage, margin status, extra capsular extension (ECE) and seminal vesicle invasion (SVI). The effects of TV, TPI and PV (as continuous and categorical variables) on PSAR were compared using Cox analysis. Results TPI, TV and PV were predictive of PSAR (p <0.05) in KM. In multivariate analysis as continuous variables, TPI and PV were predictive of PSAR (Odds ratio (OR) = 1.16 and OR = 0.65, p <0.05). As categorical variables, TPI > 20% and PV 10-35cc were predictive of PSAR (OR = 1.45 and OR = 1.25, p <0.05). TV was not predictive of PSAR in either analysis. Pathological Gleason score ≥ 7, PSA, positive margins, SVI and tumor stage T3/4 were found to be predictors of PSAR (p <0.05). Conclusions TV, TPI and PV were predictive of PSAR in univariate analysis, but only TPI and PV were predictive in multivariate analysis. TPI and PV should be considered when evaluating, assessing and counseling patients about PSAR risk.

The risk of Gleason sum under grading can be predicted to a satisfactory level using our nomogram. Predicting under grading would improve patient consulting and identify those who should consider repeat biopsy, ultimately enhancing the accuracy of prostate cancer diagnosis.

In men with a prostate of less than 35 cc tumor percent involvement is an important variable when assessing the risk of prostate specific antigen recurrence. Tumor percent involvement and prostate volume should be considered when counseling patients and determining who may benefit from heightened surveillance after radical prostatectomy.