The maximum tumour length in biopsy cores as a predictor of outcome after radical prostatectomy

Abstract

OBJECTIVES To evaluate maximum tumour length (MTL) in biopsy cores as a predictor of prostate‐specific antigen (PSA)‐failure, systemic failure, and death from prostate cancer after radical prostatectomy (RP). PATIENTS AND METHODS We assessed 209 men with clinically localized prostate cancer treated with RP; preoperative variables were correlated with unfavourable pathological characteristics in the RP specimens and with outcome after surgery, using univariate and multivariate analysis. RESULTS The median (range) MTL was 4 (0.2–19) mm and correlated with adverse pathological findings, including specimen Gleason score (P = 0.003), pT3 (P < 0.001), seminal vesicle invasion (P < 0.001) and lymph node involvement (P = 0.019) in multivariate analysis. Preoperative PSA (P < 0.001), biopsy Gleason score (P = 0.002), and MTL (P = 0.045) were independent predictors of PSA failure, whereas only MTL remained a predictor of systemic‐failure (P < 0.001) and death from prostate cancer (P = 0.004). The median (range) follow‐up after surgery was 90 (17–152) months, during which 83 patients had PSA failure, 20 developed systemic failure and 15 died from prostate cancer. CONCLUSIONS The MTL correlates well with adverse pathological findings and appears to be an independent predictor of outcome after RP. Patients with a greater MTL might have cancer with an aggressive phenotype and therefore be candidates for more aggressive therapies.