Tumor percentage involvement, prostate volume predict PSA recurrence
MedWire News: Tumor percentage involvement (TPI) and prostate volume (PV) are independent predictors for prostate-specific antigen (PSA) recurrence, but tumor volume (TV) is not, researchers report.
Matthew Uhlman (Duke University Medical Center, Durham, North Carolina, USA) and colleagues analyzed data from a cohort of 3528 patients who underwent radical prostatectomy (RP) between 1988 and 2008. PSA recurrence after RP was defined as any increase in PSA level greater than 0.2 ng/ml after the initial 4-week postoperative period.
On multivariate analysis, the continuous variables [sugg]TPI and PV were significantly predictive for PSA recurrence (hazard ratio (HR)=1.16 and 0.65, respectively), after adjusting for TV, TPI, PV, age at surgery, year of surgery, PSA, pathologic Gleason score, pathologic tumor stage, surgical margin status, extracapsular extension, and seminal vesicle invasion.
As categorical variables, TPI greater than 20% and PV 10–35 cm3 were predictive for PSA recurrence (HR=1.45 and odds ratio (OR)=1.25, respectively). But PSA recurrence was not found to be predicted by TV on multivariate analysis.
Uhlman et al comment in the journal Urology: “Previous studies have shown TV, TPI, and PV to be predictive of PSA recurrence. However, conflicting studies exist for TV and TPI.
“Though all three variables have been analyzed independently in the past, to our knowledge, this is the first study examining the variables within the same population in both univariate and multivariate analyses. Additionally, it is the largest cohort of patients analyzed in such a study.”
The researchers go on to note that, considered individually, TPI greater than 20% and PV < 35 cm3 had PSA recurrence predictive values comparable to or better than a pathologic stage of T3/T4, Gleason score of 7, and PSA.
They conclude: “When all variables were considered, patients with a PV less than 35 cm3 and patients with a TPI of more than 20% were found to be at an increased risk of PSA recurrence.
“TPI and PV should be considered when evaluating, assessing, and counseling patients regarding the risks of PSA recurrence.”
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By James Taylor