Importance Of Tumor Location In Patients With High Preoperative Prostate Specific Antigen Levels Treated With Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 23 Dec 2007 - 0:00 PDT

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UroToday.com- It is reported that 5-year biochemical-free survival (BFS) occurs in over 50% of men with a pre-operative PSA undergoing radical prostatectomy (RP). Dr. Magheli and colleagues investigated whether the zonal origin of the tumor in the radical prostatectomy specimen influences this outcome. This is based upon the hypothesis that transition zone tumors often had superior outcomes compared to peripheral zone tumors. Their report appears in the October 2007 issue of the Journal of Urology.

Between 1984 and 2005, 265 men were identified for having undergone an RP with a PSA >20ng/ml and having adequate data for followup. Anterior tumor location was defined as the primary component of the tumor being located anterior to the urethra. Post-operative PSA was followed and the clinical and pathological characteristics evaluated.

A total of 50 men (19%) were identified with anterior tumors and 215 (81%) with a posterior tumor. Patients with anterior prostate tumors had a lower clinical stage and less seminal vesicle involvement but no difference regarding extraprostatic extension, positive surgical margins, or lymph node involvement. There was no difference in biopsy and RP Gleason score between each group. Median followup was 6-7 years.

Multivariable analysis of preoperative clinical factors found tumor stage and biopsy Gleason score independently predictive of biochemical recurrence. Multivariable analysis of post-operative factors identified prostatectomy Gleason score, pathological stage, and positive surgical margins as predictive of biochemical recurrence. The 5- and 10-year BFS was 47% and 33% for patients undergoing RP with a PSA >20ng/ml. While patients with anterior tumors had 5- and 10-year BFS rates of 62% and 50% compared to 45% and 29% respectively for those with posterior tumors, anterior tumor location was not an independent predictor of biochemical recurrence on multivariable analyses.

Magheli A, Rais-Bahrami S, Peck HJ, Walsh PC, Epstein JI, Trock BJ, Gonzalgo ML

J Urol. 178(4): 1311- 1315, October 2007
doi:10.1016/j.juro.2007.05.143

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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