Tumour Volume to Predict Outcome in High-risk Prostate Cancer

Dawn O'Shea

December 09, 2021

A study led by Imperial College London has concluded that while pathological tumour volume (TV) is an independent predictor of oncological outcomes in high risk prostate cancer, it does not add significant prognostic value when combined with established variables.

The research team identified 251 patients with NCCN high or very high risk prostate cancer from a prospectively maintained database of patients undergoing laparoscopic radical prostatectomy between 2007 and 2019. Median follow up was 4.5 years.

On multivariable analysis, four factors were associated with time to biochemical recurrence (BCR) and time to treatment failure (TTF) - TV, pathological grade group (GG), pathological T stage (pT), and a positive margin >3 mm.

Area under the curve (AUC) for TV as a predictor of BCR and TTF at 5 years was 0.71 and 0.75, respectively. Including all four variables in the model increased AUC to 0.84 and 0.85 for BCR and TFF. A 2.50 cm TV cut off demonstrated a significant difference in time to BCR (P<0.001).

These findings show that TV, measured in histopathological specimens, is significantly associated with outcomes following radical prostatectomy for high risk prostate cancer. However, its prognostic value when combined with known predictive variables, such as pGG, pT stage and margin status, is limited.

The authors suggest future studies should look at whether segmented TV from preoperative mpMRI scans correlates with pathological TV, and independently predicts oncological outcome.

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