The role of tumor volume on outcome in prostate cancer after prostatectomy

Objective: Significant study has been made of the role of tumor volume contributing to outcome in prostate cancer: almost two dozen studies have been published on the subject, without clear results either for or against a relationship. Methods: An extensive MEDLINE and PUBMED search yielded fourteen articles involving > 10,600 patients describing analyses of institutional prostate cancer experiences including tumor volume after radical prostatectomy (RP). Studies were included if multivariate analysis (MVA) was performed including a variable related to tumor volume. All studies had a common outcome of biochemical disease-free (bNED) survival. Results: The more rigorous the MVA performed, the more likely tumor volume was to be independently predictive. When the analysis included only tumor volume and Gleason score, studies agreed on outcome half the time. As more variables were added to the analysis, the degree of concordance increased. The two studies with most complete MVAs concur in a volume effect on outcome in over 1470 patients. Conclusion: While no meta-analysis on the subject is possible without knowing particulars of each reported case, tumor volume as a predictive variable is likely to be less important than more frequently analyzed factors such as Gleason score and PSA. However, the studies that most completely address the complex and competing variables impacting bNED survival in prostate cancer are those that describe a relationship of tumor volume on outcome. (C) 2009 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved.