title: Maximum tumor diameter adjusted to the risk profile predicts biochemical recurrence after radical prostatectomy.
abstract: Currently, no consensus exists on the best method for tumor quantification in prostate cancer (PCA), and its prognostic value remains controversial. We evaluated how a newly defined maximum tumor diameter (MTD) might contribute to the prediction of biochemical recurrence (BCR) in a consecutive series of PCA patients treated with radical prostatectomy (RP). Patients with PCA who underwent RP without neoadjuvant therapy at a single center were included for analysis. MTD was defined as the largest diameter of all identified tumors in all three dimensions (i.e., length, width, or depth) of the prostate ("Basel technique"). Cox regression models addressed the association of MTD with BCR in three risk groups (low risk-prostate-specific antigen (PSA) < 10 ng/ml, pT2, and Gleason score (GS) ≤ 6; intermediate risk-PSA ≥ 10 and <20 ng/ml and/or pT2 and GS = 7; high risk-PSA > 20 ng/ml or pT3 or GS ≥ 8) and whole cohort. Within a median follow-up of 44 months (interquartile range (IQR) 23-66), 48 patients (9.4 %) in the intermediate-risk and high-risk groups experienced BCR. In multivariate Cox regression analysis, PSA, pathological stage (pT stage), GS, positive surgical margins (PSMs), and MTD > 19.5 mm were independent predictors for BCR (p < 0.05). In subgroup analysis, MTD as a nominal variable (<24.5 and >24.5 mm) was the only independent predictor of BCR in the intermediate-risk group (hazard ratio (HR) 9.933, 95 % confidence interval (CI) 2.070-47.665; p < 0.05). MTD is an independent risk factor of BCR in PC patients after RP. The combination of the MTD with other well-known prognostic factors after RP may improve decision-making concerning follow-up intensity or adjuvant treatment.
authors.affiliation: Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland, georg.mueller@usb.ch.
authors.forename: Georg
authors.initials: G
authors.lastname: Müller
authors.forename: Malte
authors.initials: M
authors.lastname: Rieken
authors.forename: Gernot
authors.initials: G
authors.lastname: Bonkat
authors.forename: Joel Roman
authors.initials: JR
authors.lastname: Gsponer
authors.forename: Tatjana
authors.initials: T
authors.lastname: Vlajnic
authors.forename: Christian
authors.initials: C
authors.lastname: Wetterauer
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Gasser
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Wyler
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
authors.forename: Lukas
authors.initials: L
authors.lastname: Bubendorf
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D012307:Risk Factors