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Minimal Tumor Volume May Provide Additional Prognostic Information In Good Performance Patients After Radical Prostatectomy
Thomas J Guzzo, Manish A Vira, Wei-Ting Hwang*, John E. Tomaszewski*, Keith VanArsdalen, Alan J. Wein, S. Bruce Malkowicz
University of Pennsylvania, Philadelphia, PA

Introduction: The significance of tumor volume (TV) as a predictor of biochemical failure after radical prostatectomy (RP) remains debatable. TV determinants also entail significant time and cost. Estimated TV employing provides an economical alternative to determining this parameter. We evaluated the prognostic value of estimated TV in patients undergoing RP in predicting PSA failure.
Methods: We retrospectively reviewed the clinical and pathologic features of 865 patients who underwent RP at our institution from 1991 to 1999. TV, preoperative PSA, final Gleason score, percent of positive biopsies and clinical stage were evaluated using univariate and multivariable analysis to determine their association with biochemical failure. Patients were statified into five catagories based on estimated TV (<2%,2-10%,11-25%,26-50%,>50%). Patients were further stratified into good risk categories (PSA<10, Gleason Score <7 and < T1c stage) to analyze the prognostic significance of TV in this subpopulation.
Results: Of our 865 patients, 124 (14.3%) progressed to biochemical failure with a mean follow up of 60 months. Estimated TV was significantly associated with biochemical failure on univariate analysis (p=0.024). In low risk patients (PSA <10, Gleason score <7, clinical stage T1c or less) minimal TV (<2%) is associated with a lower risk of biochemical failure on multivariable analysis (HR 2.0, 95% CI 1.09 -3.68, p=0.025).
Conclusions: In RP patients with favorable clinical and pathologic characteristics, minimal TV is associated with a decreased risk of biochemical failure. In carefully selected patients, estimated TV may provide additional prognostic information in regard to risk stratification for PSA progression and biochemical failure.

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