title: Tumor percentage but not number of tumor foci predicts disease-free survival after radical prostatectomy especially in high-risk patients.
abstract: OBJECTIVE
  To evaluate the predictive value of tumor volume (TV), tumor percentage (TP), and number of tumor foci (NF) in patients with prostate cancer. The prognostic relevance of TV, TP, and NF as predictors of biochemical recurrence (BCR) following radical prostatectomy (RPE) is controversial.
  
  
  METHODS
  The cohort consisted of 758 referred subjects who underwent RPE between 2000 and 2005 at the University of Muenster. The mean time of follow-up was 62 months. TV, TP, and NF were estimated visually with the assistance of a pathologic mapping grid for embedded whole-mount RPE specimens. In addition, TV and TP were assessed in a categorized fashion by using quartiles as cutoff points. Subgroup analyses for high- and low-risk patients using univariate and multivariate Cox proportional hazard analyses for BCR were performed.
  
  
  RESULTS
  TV, TP, and NF were strongly related to tumor stage, Gleason score, surgical margin status, and preoperative prostate-specific antigen (PSA). In univariate analysis, all pathologic parameters including TV, TP, and NF were predictive for BCR. In multivariate analysis, only TP, tumor stage, and PSA level were independent predictors. In subgroup analysis, TP was an independent predictor for BCR in the high-risk group but not in the low-risk group.
  
  
  CONCLUSIONS
  TP, but not TV or NF, was found to be an independent predictor for BCR in patients after RPE. TP seems to be more relevant in high-risk patients (i.e., any of the following: > pT2, Gleason score > 6, or PSA > 20 ng/ml).
authors: Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany. Electronic address: reemt.hinkelammert@ukmuenster.de.
authors: Reemt
authors: R
authors: Hinkelammert
authors: Department of Urology, University Hospital Cologne, Cologne, Germany.
authors: Okyaz
authors: O
authors: Eminaga
authors: Institute of Pathology, Schüttorf, Germany.
authors: Olaf
authors: O
authors: Bettendorf
authors: Institute of Pathology, Saarbrücken, Germany.
authors: Elke
authors: E
authors: Eltze
authors: Institute of Pathology, Medizinische Hochschule, Hannover, Germany.
authors: Mahmoud
authors: M
authors: Abbas
authors: Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany.
authors: Lothar
authors: L
authors: Hertle
authors: Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany.
authors: Axel
authors: A
authors: Semjonow
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D017430:Prostate-Specific Antigen
keywords: multifocal; prognosis; prostate cancer; radical prostatectomy; tumor volume