CALCULATED PROSTATE-CANCER VOLUME GREATER-THAN 4.0 CM(3) IDENTIFIES PATIENTS WITH LOCALIZED PROSTATE-CANCER WHO HAVE A POOR-PROGNOSIS FOLLOWING RADICAL PROSTATECTOMY OR EXTERNAL-BEAM RADIATION-THERAPY

Purpose: Patients with palpable extraprostatic disease (T-3) have a po or prostate-specific antigen (PSA) failure-free (bNED) survival rate a fter radical prostatectomy (RP) or external-beam radiation therapy (RT ). This study was performed to validate or refute the prognostic value of the previously defined calculated prostate cancer volume (cV(Ca)). Patients and Methods: For patients with clinically localized disease (T-1c,T-2), a COX regression multivariable analysis was used to assess the ability of the cV(Ca) value to predict time to posttherapy PSA fa ilure following RP or RT.Results: The cV(Ca) value was a significant p redictor (P less than or equal to .0005) of time to posttherapy PSA fa ilure in both an RP and PT data set independent of the one used to der ive the cV(Ca)-based clinical staging system, In both RP- and RT manag ed patients, estimates of 3-year bNED survival were not statistically different for patients with either T-1c,T-2 disease and a cV(Ca) great er than 4.0 cm(3) (RP, 27%; PT, 18%) or T-3 disease (RP, 37%; RT, 34%) . Despite pathologic T-2 disease, the 3-year estimate of bNED survival was at most 51% in RP managed patients with T-1c,T-2 disease and cV(C a) greater than 4.0 cm(3). Conclusion: A cV(Ca) greater than 4.0 cm(3) identified patients with T-1c,T-2 disease whose bNED survival was poo r after PT or RP despite pathologic T-2 disease that suggests the pres ence of occult micrometastatic disease in many of these patients. Pros pective randomized trials to evaluate the impact on survival of adjuva nt systemic therapy in these high-risk patients are justified. J Clin Oncol 16:3094-3100. (C) 1998 by American Society of Clinical Oncology.