Tumor Percent Involvement Predicts Prostate Specific Antigen Recurrence After Radical Prostatectomy Only in Men With Smaller Prostate

Uhlman, Matthew A.; Sun, Leon; Stackhouse, Danielle A.; Polascik, Thomas J.; Mouraviev, Valdmir; Robertson, Cary N.; Albala, David; Moul, Judd W.

doi:10.1016/j.juro.2009.11.046

Cited by 14 publications

(14 citation statements)

References 24 publications

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“…There are a number of pre-and postoperative predictors of BCR and progression of disease, of which Gleason sum, prostate-specific antigen (PSA) level, and stage of tumour are the most important [2] . Extraprostatic extension (EPE) and positive surgical margin (PSM) rates postoperatively are also associated with a higher rate of BCR [3][4][5][6][7][8][9][10] . Multifocality of PSMs is predictive of higher BCR rates, but the location of PSMs is less established as a predictor [11] .…”

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confidence: 99%

Prostate Volume and Its Correlation with Histopathological Outcomes in Prostate Cancer

Sooriakumaran¹,

Srivastava²,

Bhagat³

et al. 2011

Urol Int

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Introduction: There is a paucity of data investigating the relationship between histopathological variables of oncologic importance and prostate volume, and we aimed to investigate this. Patients and Methods: 2,207 consecutive patients who underwent robotic-assisted radical prostatectomy were studied. Preoperative demographic and both pre- and postoperative histopathological parameters were compared among the small (<40 cm³), intermediate (40–70 cm³), and large (>70 cm³) prostate groups. Results: Patients with smaller prostates were younger, had slightly lower BMIs, and lower prostate-specific antigen (PSA) levels than those with larger prostates (p < 0.001). They also had worse histopathological criteria (Gleason, core positivity, and maximum percent cancer) on preoperative biopsy and had worse radical specimen Gleason sums (p < 0.001), percent cancer (p < 0.001), and pathological stage (p = 0.016). 11.5% of the men in the small prostate group suffered a positive surgical margin (PSM) compared to 8.3 and 5.6% in the intermediate and large prostate groups, respectively (p = 0.008). Basilar, posterolateral, and multifocal PSMs were commoner in the small prostate group. Conclusions: Younger men have smaller prostates and worse preoperative histopathological parameters despite lower PSA values. Men with small prostates undergoing robotic-assisted radical prostatectomy have worse final Gleason sums, tumour volume, extraprostatic extension, and PSM rates than those with larger prostates.

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confidence: 99%

Prostate Volume and Its Correlation with Histopathological Outcomes in Prostate Cancer

Sooriakumaran¹,

Srivastava²,

Bhagat³

et al. 2011

Urol Int

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“…On multivariate analysis, one of these variables could drop out and lose its prognostic significance. Most studies evaluating the prognostic impact of TV or PTV at RP include all patients, regardless of pathological stage . We also reported the prognostic value of PTV measured using computer‐assisted planimetry in organ‐confined prostate cancer …”

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confidence: 99%

“…showed that TV was independently associated with prostate cancer progression when controlling for PSA level, Gleason score and stage . The effect of TV as an independent predictor of prostate cancer outcomes continues to be controversial, although several studies have sought to address this issue . The primary tumor classification of prostate cancer is defined in terms of the percentage of tumor size only in organ‐confined diseases.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 The effect of TV as an independent predictor of prostate cancer outcomes continues to be controversial, although several studies have sought to address this issue. [13][14][15][16][17] The primary tumor classification of prostate cancer is defined in terms of the percentage of tumor size only in organ-confined diseases. Specifically, tumors that occupy less than one-half of one lobe are classed as T2a, whereas those that occupy more than one-half of one lobe are classed as T2b.…”

Section: Introductionmentioning

confidence: 99%

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High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3a prostate cancer with a negative surgical margin

et al. 2013

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Abbreviations & Acronyms BCR = biochemical recurrence CI = confidence interval HR = hazard ratio LVI = lymphovascular invasion OR = odds ratio PSA = prostate-specific antigen PTV = percent tumor volume ROI = region of interest RP = radical prostatectomy SD = standard deviation TV = tumor volume Objectives: To evaluate the impact of percent tumor volume and surgical margin status on biochemical recurrence in pT3-T4 prostate cancer. Methods: A total of 397 patients who had pT3-T4N0 diseases and did not receive neoadjuvant or adjuvant therapy were included for analysis. Results: In the entire cohort, prostate-specific antigen (per 1 ng/mL increase; hazard ratio 1.019; P = 0.002), pathological stage (T3b-T4 vs T3a; hazard ratio 2.283; P < 0.001), Gleason score (≥8 vs ≤6; hazard ratio 5.290; P = 0.005), surgical margin status (multiple positive vs negative; hazard ratio 1.839; P = 0.003) and lymphovascular invasion (present vs absent; hazard ratio 1.641; P = 0.008) were independent predictors of recurrence. Percent tumor volume was an independent predictor of recurrence in T3a diseases with negative surgical margins. In analysis using receiver operating characteristic curve, a threshold of 12% showed the best balance of sensitivity and specificity, 66% and 67%, respectively. The 5-year recurrence-free survival rates of pT3a diseases with negative surgical margin were 85.2% for percent tumor volume ≤12% and 57.7% for percent tumor volume >12% (P < 0.001). Patients with pT3a with negative surgical margins and percent tumor volume >12% showed comparable 5-year recurrence-free survival rate compared with those with pT3a with positive surgical margin (57.7% vs 57.6%; P = 0.763). Conclusions: Despite having less impact on recurrence than other clinicopathological variables in pT3-T4 prostate cancer, percent tumor volume can further improve recurrence risk stratification in pT3a diseases with negative surgical margins.

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“…Using different source of energy, focal therapy can treat selected areas of the prostate [18,19] while minimizing damage to surrounding structures such as the bladder neck, rectum, external urinary sphincter, and neurovascular bundles [17,20]. It is estimated that nearly one-third of men with localized PCa have unilateral disease and could be considered candidates for hemiablation therapy (HAT) [21][22][23]. The aim of our study was to assess the probability that patients with low-risk PCa would develop unfavorable disease features (UDF) while under AS for the purpose of estimating the benefit of immediate HAT.…”

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Outcome of repeated prostatic biopsy during active surveillance: implications for focal therapy

et al. 2014

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Tumor Percent Involvement Predicts Prostate Specific Antigen Recurrence After Radical Prostatectomy Only in Men With Smaller Prostate

Cited by 14 publications

References 24 publications

Prostate Volume and Its Correlation with Histopathological Outcomes in Prostate Cancer

Prostate Volume and Its Correlation with Histopathological Outcomes in Prostate Cancer

High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3a prostate cancer with a negative surgical margin

Outcome of repeated prostatic biopsy during active surveillance: implications for focal therapy

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