title: Calculated prostate cancer volume greater than 4.0 cm3 identifies patients with localized prostate cancer who have a poor prognosis following radical prostatectomy or external-beam radiation therapy.
abstract: OBJECTIVE
  Patients with palpable extraprostatic disease (T3) have a poor prostate-specific antigen (PSA) failure-free (bNED) survival rate after radical prostatectomy (RP) or external-beam radiation therapy (RT). This study was performed to validate or refute the prognostic value of the previously defined calculated prostate cancer volume (cV(Ca)).
  
  
  METHODS
  For patients with clinically localized disease (T1c,2), a Cox regression multivariable analysis was used to assess the ability of the cV(Ca) value to predict time to posttherapy PSA failure following RP or RT.
  
  
  RESULTS
  The cV(Ca) value was a significant predictor (P < or = .0005) of time to posttherapy PSA failure in both an RP and RT data set independent of the one used to derive the cV(Ca)-based clinical staging system. In both RP- and RT-managed patients, estimates of 3-year bNED survival were not statistically different for patients with either T1c,2 disease and a cV(Ca) greater than 4.0 cm3 (RP, 27%; RT, 18%) or T3 disease (RP, 37%; RT, 34%). Despite pathologic T2 disease, the 3-year estimate of bNED survival was at most 51% in RP-managed patients with T1c,2 disease and cV(Ca) greater than 4.0 cm3.
  
  
  CONCLUSIONS
  A cV(Ca) greater than 4.0 cm3 identified patients with T1c.2 disease whose bNED survival was poor after RT or RP despite pathologic T2 disease that suggests the presence of occult micrometastatic disease in many of these patients. Prospective randomized trials to evaluate the impact on survival of adjuvant systemic therapy in these high-risk patients are justified.
authors.affiliation: Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA 02215, USA. adamico@jcrt.harvard.edu
authors.forename: A V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: R
authors.initials: R
authors.lastname: Whittington
authors.forename: S B
authors.initials: SB
authors.lastname: Malkowicz
authors.forename: D
authors.initials: D
authors.lastname: Schultz
authors.forename: I
authors.initials: I
authors.lastname: Kaplan
authors.forename: C J
authors.initials: CJ
authors.lastname: Beard
authors.forename: J E
authors.initials: JE
authors.lastname: Tomaszewski
authors.forename: A A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: K R
authors.initials: KR
authors.lastname: Loughlin
authors.forename: J P
authors.initials: JP
authors.lastname: Richie
authors.forename: A
authors.initials: A
authors.lastname: Wein
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D012044:Regression Analysis