Anterior or Posterior Prostate Cancer Tumor Nodule Location Predicts Likelihood of Certain Adverse Outcomes at Radical Prostatectomy

Abstract

Context.— Effect of tumor nodule (TN) location in the prostate on adverse radical prostatectomy (RP) outcomes is not well studied in contemporary cohort. Objective.— To investigate the significance of TN location with respect to extraprostatic extension (EPE), seminal vesicle invasion (SV+), and positive margin status (SM+) in 1388 RPs. Design.— Each TN at RP was independently graded, staged, and volumetrically assessed. TNs with at least 80% of their volume occupying either the anterior or posterior part of the prostate were categorized accordingly and included in our study, while all other TNs were excluded. Results.— A total of 3570 separate TNs (median = 3 per RP; range = 1–7 per RP) were scored. There were 1320 of 3570 (37%) anterior TNs and 2250 of 3570 (63%) posterior TNs. Posterior TNs were more likely to be higher grade, and exhibit EPE (18% versus 9.4%) and SV+ (4% versus 0.15%), all P < .001. Anterior TNs with EPE were more likely to exhibit SM+ than posterior TNs with EPE (62% versus 30.8%, P < .001). TN location, grade, and volume were significant factors associated with adverse RP outcomes in our univariable analysis. When we controlled for grade and tumor volume in a multivariable analysis using anterior TN location as a reference, posterior TN location was an independent predictor of EPE and SV+ and was less likely to be associated with SM+ (odds ratio = 3.1, 81.5, and 0.7, respectively). Conclusions.— These associations may be useful in preoperative surgical planning, particularly with respect to improving radiographic analysis of prostate cancer.

Clinicopathologic Significance of Anterior Prostate Cancer

“…This would account for the observed lower detection rates of APC, with the possibility that some cases progressed to an advanced stage and surgically incurable disease. Some recent studies have also demonstrated a high incidence of APC, ranging up to 30% of reported series 13,17,33. These studies are; however, not comparable with our current series of cases, as they included what were described as anterior dominant tumors, rather than cancers arising in and confined to the anterior prostate.…”

“…Some recent studies have also demonstrated a high incidence of APC, ranging up to 30% of reported series. 13,17,33 These studies are; however, not comparable with our current series of cases, as they included what were described as anterior dominant tumors, rather than cancers arising in and confined to the anterior prostate. Interestingly, in an earlier study, it was noted that the percentage of anterior tumors gradually increased from 10.8% in 2000 to 23.3% in 2004, which predated the widespread use of mpMRI.…”

“…While mpMRI and targeted biopsies significantly improve prostate cancer detection, 21,22 their utilization is not universal-primarily due to cost and, as a consequence, the results between series are not comparable. Some studies do not mention if mpMRI testing was undertaken, 13,16,33 while in another only 24.5% of the patients underwent examination by mpMRI. 32 In a further study, all 728 patients had mpMRI; however, this study included anterior dominant as well as anterior-only tumors.…”

Tumor Location and a Tumor Volume over 2.8 cc Predict the Prognosis for Japanese Localized Prostate Cancer

“…However, the zonal location offers no advantage over the well-established prognostic factors in predicting recurrence. Some more detailed anatomical differentiation (anterior, posterior, the apex of prostate, bladder neck) also revealed the difference in tumor location on prognosis [ 42 , 43 ]. Magheli et al found that tumors in the anterior prostate were associated with favorable pathological features and improved biochemical-free survival, although it was not an independent predictor of BCR [ 42 ].…”