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Tumor volume in insignificant prostate cancer: Increasing threshold gains increasing risk
Author(s) -
Schiffmann Jonas,
Connan Judith,
Salomon Georg,
Boehm Katharina,
Beyer Burkhard,
Schlomm Thorsten,
Tennstedt Pierre,
Sauter Guido,
Karakiewicz Pierre I.,
Graefen Markus,
Huland Hartwig
Publication year - 2015
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.22889
Subject(s) - prostate cancer , medicine , biochemical recurrence , proportional hazards model , urology , prostatectomy , pathological , oncology , breakpoint cluster region , prostate , cancer , receptor
BACKGROUND An increased tumor volume threshold (<2.5 ml) is suggested to define insignificant prostate cancer (iPCa). We hypothesize that an increasing tumor volume within iPCa patients increases the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS We relied on RP patients treated between 1992 and 2008. Multivariable Cox regression analyses predicting BCR within patients harboring favorable pathological characteristics (≤pT2, pN0/Nx, Gleason 3 + 3). Kaplan–Meier analysis was performed for BCR‐free survival within iPCa patients (≤pT2, pN0/Nx, Gleason 3 + 3, tumor volume: <0.5 vs. 0.5–2.49 ml). RESULTS From 1,829 patients, 141 (7.7%) and 310 (16.9%) harbored iPCa (tumor volume: <0.5 vs. 0.5–2.49 ml), respectively. Of those, 21 (14.9%) versus 31 (10.0%) had PSA >10 ng/ml. Tumor volume achieved independent predictor status for BCR. Specifically, iPCa patients with increasing tumor volume (0.5–2.49 ml) were at higher risk of BCR after RP than those with tumor volume <0.5 ml (HR: 8.8, 95% CI: 1.2–65.9, P = 0.04). Kaplan–Meier analysis recorded superior BCR‐free survival in iPCa patients with lower tumor volume (<0.5 ml) (log‐rank P = 0.009). The 10‐year cancer‐specific death rate was 0 versus 0.5%. CONCLUSIONS Contemporary iPCa definition incorporates intermediate and high‐risk patients (PSA: 10–20 and >20 ng/ml). Despite most favorable pathological characteristics, iPCa patients are not devoid of BCR after RP. Moreover, iPCa patients were at higher risk of BCR, when increasing tumor volume up to 2.49 ml was at play. Taken together the contemporary concept of iPCa is suboptimal. Especially, an increased tumor volume threshold for defining iPCa cannot be recommended according to our data. Clinicians might take these considerations into account during decision‐making process. Prostate 75:45–49, 2015 . © 2014 Wiley Periodicals, Inc.