Prostate weight and prostate cancer outcomes after radical prostatectomy: Results from the SEARCH cohort study.

Smaller prostates have been linked to unfavorable clinical characteristics and poor short-term outcomes following radical prostatectomy (RP). We examined the relation between prostate weight at RP and prostate cancer (PC) outcomes post-RP.

Men in the SEARCH cohort undergoing RP between 1988 and 2017 (N = 6242) were studied for PC-specific mortality (PCSM) as the primary outcome, and for biochemical recurrence (BCR), castration-resistant PC (CRPC) and metastasis as secondary outcomes. Hazard ratios (HR) and 95% confidence intervals (CI) were determined for associations between prostate weight and outcomes using Fine-Gray competing risk regression multivariable analyses. Sensitivity analyses were also carried out following exclusion of: (i) men with extreme prostate weights (<20 g and ≥100 g); and (ii) men with elevated prostate specific antigen (PSA) levels.

Median values for age, pre-RP PSA and prostate weight were 63 years, 6.6 ng/ml, and 42.0 g, respectively. During a median follow-up of 7.9 years, 153 (3%) died from PC, 2103 (34%) had BCR, 203 (3%) developed CRPC, and 289 (5%) developed metastases. Prostate weight was not associated with PCSM in the main analyses (multivariable HR = 1.43; 95% CI: 0.87-2.34) or in sensitivity analyses. Prostate weight was inversely associated with BCR in the main analyses (multivariable HR = 0.70; 95%CI: 0.61-0.79) which was unchanged in sensitivity analyses. HRs for prostate weight and CRPC and metastasis were elevated but statistical significance was not attained. Similar results were observed in sensitivity analyses.

Inconsistent results for prostate weight and short-term vs longer-term outcomes highlight the need to better understand the complex biology leading to prostate size and the relevance of prostate size as a predictor of PC outcomes.

The Prostate. 2021 Dec 14 [Epub ahead of print]

Sean Kennedy Barlow, Taofik Oyekunle, Jessica L Janes, Amanda M De Hoedt, William J Aronson, Christopher J Kane, Christopher L Amling, Matthew R Cooperberg, Zachary W Klaassen, Martha K Terris, Stephen J Freedland, Ilona Csizmadi

Division of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA., Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics Shared Resource, Duke University School of Medicine, Durham, North Carolina, USA., Department of Urology, University of California Los Angeles Medical Center, Los Angeles, California, USA., Department of Urology, University of California San Diego Health System, San Diego, California, USA., Department of Urology, Oregon Health and Science University, Portland, Oregon, USA., Department of Urology, University of California San Francisco Medical Center, San Francisco, California, USA., Department of Surgery, Augusta University, Augusta, Georgia, USA., Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, USA.