Prostate Cancer Recurrence Risk Lower With Anterior Tumors

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Following laparoscopic radical prostatectomy, men with posterior index tumors had 76% increased risk of biochemical recurrence vs those with anterior prostate tumors.
Following laparoscopic radical prostatectomy, men with posterior index tumors had 76% increased risk of biochemical recurrence vs those with anterior prostate tumors.

Biochemical recurrence of prostate cancer (PCa) following laparoscopic radical prostatectomy is less likely if the index tumor is in the anterior rather than posterior part of the prostate, according to study findings presented at the American Urological Association 2018 annual meeting.

Investigators concluded that anterior index tumor location could be a new pathologic factor associated with lower biochemical recurrence (BCR) risk following laparoscopic radical prostatectomy (LRP), especially in high-risk patients.

Kimiharu Takamatsu, MD, of Keio University School of Medicine in Tokyo, and colleagues reviewed outcomes from 1082 patients who underwent LRP, including 638 patients with pathologic data on the index tumor location. If there were several masses, they defined the largest lesion as the index tumor. The tumor was located anteriorly in 296 patients and posteriorly in 342. The anterior group was more likely than the posterior group to have a high initial PSA level (10 ng/mL or higher) (24.3% vs 15.5%) and had a larger tumor diameter (median 1.6 vs 1.3 cm). The anterior group, however, had less pT3 disease (26.1% vs 37.1%) and a lower pathologic Gleason score (3+4 or less).

During a median follow-up period of 58.7 months, 79 patients (12.4%) experienced BCR. On multivariate analysis, posterior index tumor location was associated with a significant 76% increased likelihood of BCR compared with anterior location. The study identified other predictors of BCR as well. An initial PSA level of 10 ng/mL or higher was associated with a significant 2.4-fold higher risk of BCR compared with a lower initial PSA level. Pathologic Gleason scores of 4+3 or higher and positive surgical margins were associated with a 3-fold and 2.6-fold increased risk of BCR, respectively.

The increased risk of BCR among men with posterior vs anterior index tumors was greater among those with an initial PSA level of 10 ng/mL or higher, pT3 disease, and Gleason score of 3+4 or higher.

Reference

  1. Takamatsu K, Matsumoto K, Takeda T, et al. Impact of tumor location on biochemical recurrence after laparoscopic radical prostatectomy. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. Abstract MP05-20.

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