Document Detail


Maximal tumor diameter and the risk of PSA failure in men with specimen-confined prostate cancer.
MedLine Citation:
PMID:  16286117     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To evaluate whether the maximal tumor diameter (MTD) is significantly associated with the time to postoperative prostate-specific antigen (PSA) failure. METHODS: Between 1986 and 2002, 781 men with clinical Stage T1c-T2 prostate cancer underwent radical prostatectomy. The MTD was recorded as the maximal dimension of the largest single focus of cancer from all 3-mm step sections. The median follow-up was 5.4 years (range 0.1 to 14.9); 242 men (31%) experienced PSA failure. A Cox regression analysis was used to determine the predictors of time to postoperative PSA failure. Kaplan-Meier estimates of PSA failure-free survival were made, dichotomized about the median MTD value, and compared using a two-sided log-rank test. RESULTS: The value of the MTD was significantly associated with the time to PSA failure (adjusted hazard ratio 1.04, 95% confidence interval 1.01 to 1.07, P = 0.004), controlling for preoperative PSA level (P < 0.0001), prostatectomy Gleason score (P < 0.0001), and T stage (P < 0.0001). When margin status was added (P = 0.0004), the MTD approached statistical significance (P = 0.07). For patients with a preoperative PSA level of less than 10 ng/mL, prostatectomy Gleason score of 3 + 4 = 7 or less, Stage pT2-T3a, and negative margins, the value of the MTD significantly (P = 0.05) stratified the time to PSA failure, when dichotomized about the median value (13 mm), with 7-year PSA failure estimates of 17% versus 8%. CONCLUSIONS: Whether patients with traditionally low-risk but large MTD prostate cancer fare better when treated with adjuvant radiotherapy compared with salvage radiotherapy remains to be answered in the setting of a randomized trial.
Authors:
Tomas Dvorak; Ming-Hui Chen; Andrew A Renshaw; Marian Loffredo; Jerome P Richie; Anthony V D'Amico
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Urology     Volume:  66     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-15     Completed Date:  2005-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1024-8     Citation Subset:  IM    
Affiliation:
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Follow-Up Studies
Humans
Male
Middle Aged
Prostate-Specific Antigen / blood*
Prostatectomy
Prostatic Neoplasms / blood*,  pathology*,  surgery
Risk Factors
Time Factors
Treatment Failure
Chemical
Reg. No./Substance:
EC 3.4.21.77/Prostate-Specific Antigen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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