Clinical Usefulness of Prostate and Tumor Volume Related Parameters following Radical Prostatectomy for Localized Prostate Cancer

We evaluated whether the prediction of biochemical recurrence after radical prostatectomy is enhanced by any of 6 parameters, including prostate volume, total tumor volume, high grade total tumor volume, the ratio of high grade total tumor volume to total tumor volume, the ratio of total tumor volum...

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Bibliographic Details
Published in:The Journal of urology Vol. 201; no. 3; p. 535
Main Authors: Ito, Yujiro, Udo, Kazuma, Vertosick, Emily A, Sjoberg, Daniel D, Vickers, Andrew J, Al-Ahmadie, Hikmat A, Chen, Ying-Bei, Gopalan, Anuradha, Sirintrapun, S Joseph, Tickoo, Satish K, Scardino, Peter T, Eastham, James A, Reuter, Victor E, Fine, Samson W
Format: Journal Article
Language:English
Published: United States 01.03.2019
Subjects:
Aged
Humans
Male
Middle Aged
Neoplasm Recurrence, Local - blood
Neoplasm Recurrence, Local - diagnosis
Predictive Value of Tests
Prostate - pathology
Prostate-Specific Antigen - blood
Prostatectomy - methods
Prostatic Neoplasms - blood
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Retrospective Studies
Tumor Burden
ISSN:1527-3792, 1527-3792
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Summary:We evaluated whether the prediction of biochemical recurrence after radical prostatectomy is enhanced by any of 6 parameters, including prostate volume, total tumor volume, high grade total tumor volume, the ratio of high grade total tumor volume to total tumor volume, the ratio of total tumor volume to prostate volume and/or the ratio of high grade total tumor volume to prostate volume. A total of 1,261 patients who underwent radical prostatectomy during a 3-year period had tumor maps constructed with the Gleason pattern denoted as low-3 or high-4 or 5 and volumetric data generated using commercially available software. Univariate Cox regression models were used to assess whether each volume related parameter was associated with biochemical recurrence after radical prostatectomy. A multivariable Cox regression base model (age, prostate specific antigen, Gleason score/grade group, pathological stage and margin status) was compared with 6 additional models (base model plus each volume related parameter) to evaluate enhancement in predictive accuracy. Decision curve analysis was performed to determine the clinical utility of parameters that enhanced predictive accuracy. On univariate analysis each parameter was significantly associated with biochemical recurrence except prostate volume. Predictive accuracy of the multivariable base model was high (c-index = 0.861). Adding volume related parameters marginally enhanced discrimination. Decision curve analysis failed to show added benefit even for high grade total tumor volume/total tumor volume, which was the parameter with the highest discriminative improvement. Tumor volume related parameters are significantly associated with radical prostatectomy but do not add important discrimination to standard clinicopathological variables for radical prostatectomy prediction or provide benefit across a range of clinically relevant decision thresholds. Volume related measurement is not warranted in routine pathological evaluation and reporting.
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ISSN:1527-3792
1527-3792
DOI:10.1016/j.juro.2018.09.060