Is tumour volume an independent predictor of outcome after radical prostatectomy for high-risk prostate cancer?

Preoperative PSA, ISUP grade group (GG), prostate examination and multiparametric MRI (mpMRI) form the basis of prostate cancer staging. Unlike other solid organ tumours, tumour volume (TV) is not routinely used aside from crude estimates such as maximum cancer core length. The aim of this study is to assess the role of TV as a marker for oncological outcomes in high-risk non-metastatic prostate cancer.

A prospectively maintained database of patients undergoing minimally invasive (laparoscopic or robot-assisted laparoscopic) radical prostatectomy at a UK centre between 2007 and 2019 were analysed. A total of 251 patients with NCCN high or very high-risk prostate cancer were identified. Primary outcome measure was time to biochemical recurrence (BCR) and the secondary outcome was time to treatment failure (TTF). TV was measured on the pathological specimen using the stacking method. Multivariable cox regression analysis was used to identify factors predicting BCR and TFF. TV as a predictor of BCR and TFF was further analysed through time-dependent receiver operating characteristic (ROC) curves. Kaplan-Meier survival estimates were used to evaluate TV cut-off scores.

Median follow up was 4.50 years. Four factors were associated with BCR and TFF on multivariable analysis (TV, pathological GG, pathological T stage, positive margin >3 mm). Area under the Curve (AUC) for TV as a predictor of BCR and TTF at 5 years was 0.71 and 0.75, respectively. Including all 4 variables in the model increased AUC to 0.84 and 0.85 for BCR and TFF. A 2.50 cm TV cut off demonstrated a significance difference in time to BCR, p < 0.001.

Pathological tumour volume is an independent predictor of oncological outcomes in high risk prostate cancer but does not add significant prognostic value when combined with established variables. However, the option of accurate TV measurement on mpMRI raises the possibility of using TV as useful marker for preoperative risk stratification.

Prostate cancer and prostatic diseases. 2021 Nov 29 [Epub ahead of print]

Nicholas Raison, Pol Servian, Amit Patel, Ainkaran Santhirasekaram, Andrew Smith, Maidie Yeung, Josephine Lloyd, Ethna Mannion, Andrea Rockall, Hashim Ahmed, Mathias Winkler

Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Department of Urology, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Barcelona, Spain., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA., Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK., North West London Pathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK., Division of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK., Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. .

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