Relationship Between Tumor Density in Radical Prostatectomy Material, Preoperative Predictive Factors and Biochemical Recurrence

Abstract

Objective: In this study, we assessed the relationship between tumor density (tumor volume prostate volume ratio), preoperative predictive factors and biochemical recurrence (BR) in patients who underwent radical retropubic prostatectomy (RRP) for prostate cancer in our clinic. Materials and Methods: For the patients undergoing RRP between 2005-2015 preoperative predictive factors, postoperative prognostic factors and BR status were evaluated. Preoperative and postoperative factors were compared between the patient groups whose BR was detected as positive and negative. Subsequently, the cut-off value effecting BR of tumor density was determined and the preoperative predictive values, postoperative prognostic factors and BR rates were investigated in patients whose tumor density found low and high. Results: BR was detected in 63 of 338 patients who underwent RRP, but not in 275 patients. In BR positive patients of multivariate analysis, the prostate needle biopsy (PNB) Gleason score of preoperative predictive factors, number of focus and perineural invasion presence and only surgical margin positivity were detected to be significantly higher from the postoperative prognostic factors (p<0.001). The cut-off value of tumor density affecting BR positivity was detected as 4.34 cc/cc (AUC: 0.711, p<0.001). BR was 4.65 times higher in patients with tumor density >4.34 cc/cc compared to patients with tumor density ≤4.34 cc/cc (p<0.001, odds ratio: 4.65). Sensitivity and specifity of the tumor density of 4.34 cc/cc value for BR were detected as 68.3% and 68.4%, separately. Moreover, it was observed in multivariate analysis that prostate specific antigen (PSA) density of preoperative data, PNB tumor percentage and number of focus were solely associated with high tumor density (>4.34 cc/cc). Conclusion: In conclusion, it was found that the most important prognostic factors affecting BR were surgical margin positivity and high tumor density; PSA density, PNB tumor percentage and number of focus were alone associated with high tumor density among the preoperative predictive factors and all predictive factors were positively correlated with tumor density. Keywords: Prostate cancer, radical retropubic prostatectomy, tumor volume, tumor density, biochemical recurrence Amaç: Bu yazıda kliniğimizde prostat adenokarsinomu nedenli radikal retropubik prostatektomi (RRP) yapılan hastaların prostatektomi materyalindeki tümör dansitesinin (tümör hacminin prostat volümüne oranı) preoperatif prediktif faktörler ve biyokimyasal rekürrens (BR) ile ilişkisi araştırıldı. Gereç ve Yöntem: 2005-2015 tarihleri arasında RRP yapılan hastaların preoperatif prediktif faktörleri, postoperatif prognostik faktörleri ve BR durumları değerlendirildi. BR pozitif ve negatif saptanan hasta gruplarında preoperatif ve postoperatif faktörler karşılaştırıldı. Sonrasında tümör dansitesinin BR üzerine etkili cut-off değeri saptanarak tümör dansitesi düşük ve yüksek saptanan hastalar arasındaki preoperatif prediktif veriler, postoperatif prognostik faktörler ve BR...