Adult urologyMorphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens
Section snippets
Patients and pathologic analysis
A total of 559 untreated radical prostatectomies were performed at Stanford between January 1, 1992, and January 1, 1996. Nineteen patients were excluded because of no PSA follow-up, 6 because of hormonal therapy before radical prostatectomy, 5 because of missing information on prostate weight, 1 because of no prostate carcinoma, and 38 (6.8%) because they had two or more independent index tumors of similar size, making it impossible to determine the largest tumor. We also excluded 2 men whose
Results
The mean and median size of the largest (index) cancer was 4.16 cm3 and 2.78 cm3, respectively (Table I). On average, 2.92 additional separate cancers (mean volume 0.63 cm3) were found. The mean and median ratio of the sum of smaller cancer volumes to the index cancer volume was 15% and 6%, respectively. The mean age at radical prostatectomy (Table I) was 62.9 years (interquartile range 59 to 68); the mean and median PSA follow-up after radical prostatectomy was 3.37 and 3.2 years,
Comment
In 83% of this series of 486 radical prostatectomies, prostate carcinoma was a multifocal disease. Figure 1 shows that the secondary cancers were mostly small; 58% were less than 0.5 cm3 in volume.
The linear relationship between the index cancer volume and progression to biochemical failure is generally accepted; it is no surprise that Figure 2 shows such a relationship between the index cancer volume and PSA failure. Figure 2, however, suggests that the presence of secondary cancers appears to
Conclusions
Smaller cancers are not a significant predictor of PSA failure after radical prostatectomy; the index cancer volume is equally predictive of PSA failure after radical prostatectomy as total cancer volume (index plus smaller cancers). The significance rests solely with the largest cancer. The information in Figure 4 suggests that the largest carcinoma in the prostate may increase its volume by assimilation of adjacent independent tumors, thereby adding to the biologic importance of the index
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