title: Tumor extent in radical prostatectomy specimens: is it an independent prognostic factor for biochemical (PSA) progression following surgery?
abstract: OBJECTIVE
  The tumor volume or extent measurement in radical prostatectomy (RP) specimens is time-consuming and technically difficult. We aimed at studying the independent prognostic value of tumor extent for biochemical progression-free following RP once it is controversial.
  
  
  METHODS
  This retrospective study was based on 305 consecutive patients submitted to RP. In whole-mount and totally embedded surgical specimens, tumor extent was evaluated with a point-count semi-quantitative method and correlated to several clinical and pathological variables. Biochemical progression was defined as PSA ≥ 0.2 ng/ml; time to progression-free outcome was studied using the Kaplan-Meier product-limit analysis and univariate and multivariate analyses using the Cox stepwise logistic regression.
  
  
  RESULTS
  More extensive tumors showed significantly 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), and higher Gleason score on needle biopsies (P < 0.01) and on surgical specimens (P < 0.01). On univariate analysis, biochemical progression correlated with tumor extension (P < 0.01), preoperative PSA (P < 0.01), Gleason score on needle biopsies (P = 0.02) and on surgical specimens (P < 0.01), positive surgical margins (P = 0.01), and pathological stage (P = 0.01). There was no difference related to time of biochemical recurrence comparing less extensive with more extensive tumors (P = 0.20). In multivariate analysis, tumor extent was not predictive of biochemical progression combined to any one of the variables studied (P > 0.05).
  
  
  CONCLUSIONS
  Tumor extent did not provide in our study additional predictive information for biochemical progression following RP beyond preoperative PSA, Gleason score, positive surgical margins, and pathological stage.
authors.affiliation: Department of Pathology, School of Medicine, University of Campinas (Unicamp), Campinas, SP, Brazil.
authors.forename: Athanase
authors.initials: A
authors.lastname: Billis
authors.forename: Luciana
authors.initials: L
authors.lastname: Meirelles
authors.forename: Leandro L
authors.initials: LL
authors.lastname: Freitas
authors.forename: Luis A
authors.initials: LA
authors.lastname: Magna
authors.forename: Ubirajara
authors.initials: U
authors.lastname: Ferreira
authors.forename: Leonardo O
authors.initials: LO
authors.lastname: Reis
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen