Tumor Volume in Radical Prostatectomy Specimens: Is It an Independent Prognostic Factor for Biochemical (PSA) Progression Following Surgery?
A Billis, L Meirelles, LLL Freitas, AGE Duarte, CAM Silva, MAM Bisson, LA Magna, U Ferreira. School of Medicine, University of Campinas (Unicamp), Campinas, SP, Brazil
Background: One of the most controversial aspects of the pathologic assessment of radical prostatectomy (RP) specimens is the measurement of tumor volume. There is consensus that tumor volume by itself correlates with adverse findings at radical prostatectomy, such as Gleason score, margins of resection, pathological stage and progression following RP. The critical and controversial question concerns whether tumor volume is an independent prognostic parameter once other routinely assessed variables are accounted for.
Design: The study was based on 305 whole-mount consecutive surgical specimens. Tumor extent was evaluated with a point-count semiquantitative method previously published and correlated to age, preoperative PSA, clinical stage, Gleason score in RP, positive ressection margins, seminal vesicle invasion, and biochemical progression defined as PSA 0.2ng/mL. The data were analyzed using the Mann-Whitney test and Fisher's exact test. Time to progression-free outcome was studied using the Kaplan-Meier product-limit analysis; the comparison between the groups was done using the log-rank test. Univariate and multivariate analysis using Cox logistic regression was performed.
Results: More extensive tumors showed 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), higher Gleason score (P<0.01), and shorter time for PSA progression (p<0.01). Using univariate analysis, tumor progression correlated with tumor extension (p=0.01), preoperative PSA (p<0.01), Gleason score (p<0.01), positive surgical margins (p<0.01), and seminal vesicle invasion (p=0.01). In a multivariate analysis the p values were 0.30, 0.02, 0.01, 0.08, and 0.10 for tumor extent, preoperative PSA, positive margins, seminal vesicle invasion, and Gleason score.
Conclusions: Tumor extent did not provide additional information beyond other clinicopathologic findings in multivariate analysis. It seems that measurement of tumor extent (a time consuming procedure) is not necessary to be performed as part of the routine pathological analysis of RP specimens.
Category: Genitourinary (including renal tumors)
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 126, Wednesday Morning