title: Zonal location of prostate cancer: significance for disease-free survival after radical prostatectomy?
abstract: OBJECTIVE
  To analyze the zonal location of prostate cancer as a possible predictive feature of progression-free survival after radical prostatectomy.
  
  
  METHODS
  Prostate cancers were divided into three groups according to the percentage of cancer volume (70% or more, 31% to 69%, and 30% or less) located in the transition zone (TZ). In a total of 307 patients, 5-year progression-free probabilities were estimated for different clinical and pathologic tumor characteristics using the Kaplan-Meier method. With emphasis on the percentage of cancer volume located in the TZ, univariate and multivariate analyses were performed to calculate their prognostic significance in predicting progression-free probability.
  
  
  RESULTS
  Prostate cancer with 70% or more, 31% to 69%, and 30% or less of the cancer volume in the TZ was found in 17.3%, 6.8%, and 75.9% of the patients, respectively. Patients with tumors with 70% or more of the cancer volume in the TZ had a significantly (log-rank P = 0.0402) greater rate of biochemical cure than those with 30% or less (82.1% versus 66.2%). The increasing percentage of cancer volume located in the TZ was significantly (P = 0.0258) associated with a greater progression-free probability in univariate analysis, but did not retain independent significance (P = 0.5748) in multivariate analysis. Instead, pathologic stage (P <0.0001), lymph node involvement (P = 0.0189), and Gleason score on prostatectomy specimen (P = 0.0023) were independent prognosticators.
  
  
  CONCLUSIONS
  The location of prostate cancer in the TZ was associated with a greater overall biochemical cure rate after radical prostatectomy. However, it was not an independent prognosticator on multivariate analysis. Therefore, the knowledge about zonal location of prostate cancer offers no advantage over the well-established prognostic factors in predicting disease recurrence.
authors.affiliation: Department of Urology, University Hospital Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Augustin
authors.forename: Peter G
authors.initials: PG
authors.lastname: Hammerer
authors.forename: Jakob
authors.initials: J
authors.lastname: Blonski
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Jüri
authors.initials: J
authors.lastname: Palisaar
authors.forename: Fedor
authors.initials: F
authors.lastname: Daghofer
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Andreas
authors.initials: A
authors.lastname: Erbersdobler
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011467:Prostate / Q000000981:diagnostic imaging / Q000648:ultrastructure; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen