A PROSTATE-GLAND VOLUME OF MORE THAN 75 CM(3) PREDICTS FOR A FAVORABLE OUTCOME AFTER RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE-CANCER

Objectives. Both the benign and malignant prostatic epithelial compone nts of the prostate gland contribute to the serum prostate-specific an tigen (PSA) level. Therefore, for a given PSA, the presence of benign hyperplastic prostate tissue (BHPT) may indicate a lower cancer burden . This study was performed to assess the impact of varying amounts of BHPT on PSA failure free (bNED) survival after radical prostatectomy f or localized prostate cancer. Methods. Cox regression multivariable an alyses were performed to assess the ability of the clinical stage, PSA , biopsy Gleason score, and prostate gland volume to predict time to p ostoperative PSA failure in 885 patients. Results. In addition to the PSA (P < 0.0001), biopsy Gleason score of 8 to 10 (P < 0.0001) and of 7 (P = 0.05), and clinical Stage T2c,3a (P < 0.0001) and T2b (P = 0.00 16), the prostatectomy prostate gland volume (P < 0.0001) was a signif icant predictor of time to postoperative PSA failure. Patients with a prostatectomy prostate gland volume greater than 75-cm(3) had a 100% 4 -year bNED survival and favorable pathologic characteristics (patholog ic Stage T2, 85%; prostatectomy Gleason score 6 or less, 78% and 7, 22 %; and negative margins, 95%) despite a preoperative PSA of 10 to 20 n g/mL and more than 20 ng/mL in 28% and 13% of these men, respectively. In 75%,of these cases, lead time bias because of PSA driven repeat bi opsies provided an explanation. Conclusions. Lead;time bias because of PSA driven repeat biopsy accounted for the high 4-year bNED survival and favorable pathologic findings for most patients who had prostate c ancer coexisting in a prostate gland comprised of BHPT and a total gla nd volume in excess of 75 cm(3). An addition al explanation is needed, however, for the remaining patients. UROLOGY 52: 631-636, 1998. (C) 1 998, Elsevier Science Inc. All rights reserved.