title: Maximal tumor diameter and the risk of PSA failure in men with specimen-confined prostate cancer.
abstract: OBJECTIVE
  To evaluate whether the maximal tumor diameter (MTD) is significantly associated with the time to postoperative prostate-specific antigen (PSA) failure.
  
  
  METHODS
  Between 1986 and 2002, 781 men with clinical Stage T1c-T2 prostate cancer underwent radical prostatectomy. The MTD was recorded as the maximal dimension of the largest single focus of cancer from all 3-mm step sections. The median follow-up was 5.4 years (range 0.1 to 14.9); 242 men (31%) experienced PSA failure. A Cox regression analysis was used to determine the predictors of time to postoperative PSA failure. Kaplan-Meier estimates of PSA failure-free survival were made, dichotomized about the median MTD value, and compared using a two-sided log-rank test.
  
  
  RESULTS
  The value of the MTD was significantly associated with the time to PSA failure (adjusted hazard ratio 1.04, 95% confidence interval 1.01 to 1.07, P = 0.004), controlling for preoperative PSA level (P < 0.0001), prostatectomy Gleason score (P < 0.0001), and T stage (P < 0.0001). When margin status was added (P = 0.0004), the MTD approached statistical significance (P = 0.07). For patients with a preoperative PSA level of less than 10 ng/mL, prostatectomy Gleason score of 3 + 4 = 7 or less, Stage pT2-T3a, and negative margins, the value of the MTD significantly (P = 0.05) stratified the time to PSA failure, when dichotomized about the median value (13 mm), with 7-year PSA failure estimates of 17% versus 8%.
  
  
  CONCLUSIONS
  Whether patients with traditionally low-risk but large MTD prostate cancer fare better when treated with adjuvant radiotherapy compared with salvage radiotherapy remains to be answered in the setting of a randomized trial.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: Dvorak
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: Marian
authors.initials: M
authors.lastname: Loffredo
authors.forename: Jerome P
authors.initials: JP
authors.lastname: Richie
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D017430:Prostate-Specific Antigen