Tumor extent in radical prostatectomy specimens: is it an independent prognostic factor for biochemical (PSA) progression following surgery?

Purpose: The tumor volume or extent measurement in radical prostatectomy (RP) specimens is time-consuming and technically difficult. We aimed at studying the independent prognostic value of tumor extent for biochemical progression-free following RP once it is controversial.

Methods: This retrospective study was based on 305 consecutive patients submitted to RP. In whole-mount and totally embedded surgical specimens, tumor extent was evaluated with a point-count semi-quantitative method and correlated to several clinical and pathological variables. Biochemical progression was defined as PSA ≥ 0.2 ng/ml; time to progression-free outcome was studied using the Kaplan-Meier product-limit analysis and univariate and multivariate analyses using the Cox stepwise logistic regression.

Results: More extensive tumors showed significantly higher preoperative PSA (P < 0.01), higher clinical stage (P = 0.03), higher positive surgical margins (P < 0.01), higher pathological stage (P < 0.01), and higher Gleason score on needle biopsies (P < 0.01) and on surgical specimens (P < 0.01). On univariate analysis, biochemical progression correlated with tumor extension (P < 0.01), preoperative PSA (P < 0.01), Gleason score on needle biopsies (P = 0.02) and on surgical specimens (P < 0.01), positive surgical margins (P = 0.01), and pathological stage (P = 0.01). There was no difference related to time of biochemical recurrence comparing less extensive with more extensive tumors (P = 0.20). In multivariate analysis, tumor extent was not predictive of biochemical progression combined to any one of the variables studied (P > 0.05).

Conclusions: Tumor extent did not provide in our study additional predictive information for biochemical progression following RP beyond preoperative PSA, Gleason score, positive surgical margins, and pathological stage.