title: Prostate volume and pathologic prostate cancer outcomes after radical prostatectomy.
abstract: OBJECTIVE
  To more clearly elucidate the relationship between prostate volume (PV) and prostate cancer parameters.
  
  
  METHODS
  The Urologic Oncology Database was reviewed. A total of 3460 patients had undergone radical prostatectomy from 1988 to 2006. Of these, 2600 with complete data were included in the study and were stratified by the PV: normal (0 to 40 cm(3)), moderate (40 to 80 cm(3)), or large (greater than 80 cm(3)). The prostate cancer variables were evaluated using analysis of variance. Regression models were used to determine the role of PV in Gleason sum discordance (greater than 1 unit) controlling for prostate-specific antigen level and clinical and pathologic stage.
  
  
  RESULTS
  Of the 2600 patients, 1453 (55.2%) had a normal, 1035 (39.8%) a moderate, and 130 (5.0%) a large PV. Patients with a normal PV were more likely to have a Gleason sum greater than 6 at biopsy (46.2%) and radical retropubic prostatectomy (68.4%) compared with patients with a moderate (39.0% and 58.9%, respectively) or a large (41.5% and 57.7%, respectively) PV (P = 0.005 and P = 0.001, respectively). Patients with a normal PV had greater rates of extraprostatic extension (32.3%) and positive margins (28.2%) compared with those with a moderate (25.5% and 22.4%, respectively) or a large (23.3% and 20.3%, respectively) PV (P = 0.002 and P = 0.005, respectively). Of all 2600 patients, 55.9% had no change between the biopsy and pathologic Gleason sum, 255 (9.8%) were downgraded, and 890 (34.3%) were upgraded. Patients with a large PV had a greater rate of downgrading (16.2%) than those with a normal (8.7%) or moderate (10.5%) PV (P = 0.01). Patients upgraded had the greatest rate of pathologically advanced disease (35.3% with Stage T3 or greater, P <0.001). On multivariate regression analysis, PV (odds ratio 0.99, P = 0.005), prostate-specific antigen level (odds ratio 1.03, P <0.001), and age (odds ratio 1.03, P <0.001) were predictors of Gleason discordance +/-2.
  
  
  CONCLUSIONS
  The results of our study have shown that patients with a large PV (greater than 80 cm(3)) are more likely to have a lower Gleason sum, locally confined and less-aggressive pathologic disease, and were more often downgraded.
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kinnaman
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Wosnitzer
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.forename: Erik T
authors.initials: ET
authors.lastname: Goluboff
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen