The association between tumour density and prostate cancer recurrence following radical prostatectomy

Abstract

Purpose: Tumour density (TD) may be an independent prognostic factor in men with prostate cancer. The purpose of this study was to evaluate the association between prostate cancer TD and recurrence following radical prostatectomy. Materials and Methods: Between 1995 and 2007, 645 patients from The Ottawa Hospital or Memorial Sloan-Kettering Cancer Center who had cancer and prostate volumes measured from radical prostatectomy specimens. Tumour density was defined as the relative tumour to prostate volume (tumour volume/prostate volume) and recurrence was defined as a prostate-specific antigen (PSA) >0.2 ng/mL and rising, or postoperative use of radiation or hormonal therapy. Associations between TD and recurrence are adjusted for preoperative PSA, prostatectomy Gleason sum, tumour stage and margin status. Results: Median follow-up was 40.8 months. Tumour density was associated with preoperative PSA, Gleason sum, tumour stage and surgical margin status (all p < 0.0001). As a continuous variable, TD predicted recurrence-free survival (adjusted HR 1.34 per 10% increase in TD; p = 0.04). As a categorical variable, the group of patients with a TD of >10% had a 2.7 times greater hazard of recurrence compared to patients with a TD <5% (95%CI 1. 41, 5.19; p = 0.003). Despite the independent association between TD and recurrence, the clinical value of TD remains in question as the discriminative performance (area under the curve) of predictive models only improved from 0.865 to 0.876. Conclusions: Prostate cancer TD is associated with known prognostic factors and is also independently predictive of recurrence following radical prostatectomy.

Conspicuity of prostate cancer on multiparametric magnetic resonance imaging: A cross‐disciplinary translational hypothesis

“…These histopathological properties are informative, as Gleason grade, tumor volume, tumor cellular density, microvessel density, presence of cribriform and intraductal carcinoma, and tumors arising in the peripheral zone are all features associated with increased likelihood of disease recurrence following surgery 26–31 . As such, these pathological observations further suggest that tumor mpMRI visibility may have genuine prognostic utility.…”

The pursuit of the “perfect” biomarker in prostate cancer

“…Certainly, there are limitations particularly that the methodology for calculating volume was not standardized nor was their independent review; there was also limited follow-up and patients were not contiguous. 1 It is arguable that these may not have affected the final results, but they certainly detracted from their generalizability.…”

“…One cannot argue with the authors that tumour volume measurement in prostate cancer as a stand-alone tool is unclear. 1 Yet methods for calculating tumour volume are variable from the "eye of the pathologist" to more sophisticated digital methods. The use of volumetric analysis is now welldescribed.…”

“…1 Such tools are appealing, but the likelihood of a drastic change from prostate-specific antigen (PSA), Gleason score and stage is difficult to ignore. This study explores tumour density and found it to be an independent predictor for biochemical recurrence.…”

“…4 This digital type analysis was not universally done in this study. 1 Furthermore, illustrating tumour volume by a tumour map may be helpful to understand the location of the tumour and also the need for surgery and adjuvant treatment. Certainly, there are limitations particularly that the methodology for calculating volume was not standardized nor was their independent review; there was also limited follow-up and patients were not contiguous.…”