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Prostate Size and Risk of High-Grade, Advanced Prostate Cancer and Biochemical Progression After Radical Prostatectomy: A Search Database Study

From the Department of Urology, Johns Hopkins School of Medicine; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD; Department of Surgery, Veterans Administration Medical Center; Section of Urology, Medical College of Georgia, Augusta, GA; Urology Section, Department of Surgery, Veterans Administration, Greater Los Angeles Healthcare System; Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles; Department of Urology, San Diego Naval Hospital, San Diego; Department of Urology, Stanford University School of Medicine; Urology Section, Department of Surgery, Veterans Administration Medical Center, Palo Alto; Urology Section, Department of Surgery, Veterans Administration Medical Center; Department of Urology, University of California, San Francisco School of Medicine, San Francisco, CA

Address reprint requests to Stephen J. Freedland, MD, James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 21287-2101; e-mail: sfreedl1{at}jhmi.edu

PURPOSE: Prostate growth and differentiation are under androgenic control, and prior studies suggested that tumors that develop in hypogonadal men are more aggressive. We examined whether prostate weight was associated with tumor grade, advanced disease, or risk of biochemical progression after radical prostatectomy (RP).

PATIENTS AND METHODS: We evaluated the association of prostate weight with pathologic tumor grade, positive surgical margins, extracapsular disease, and seminal vesicle invasion using logistic regression and with biochemical progression using Cox proportional hazards regression among 1,602 men treated with RP between 1988 and 2003 at five equal-access medical centers, which composed the Shared Equal Access Regional Cancer Hospital (SEARCH) Database.

RESULTS: In outcome prediction models including multiple predictor variables, it was found that the predictor variable of prostate weight was significantly inversely associated with the outcomes of high-grade disease, positive surgical margins, extracapsular extension (all P .004), and biochemical progression (comparing prostate weight < 20 v 100 g: relative risk = 8.43; 95% CI, 2.9 to 24.0; P < .001). Similar associations were seen between preoperative transrectal ultrasound–measured prostate volume and high-grade disease, positive surgical margins, extracapsular extension (all P .005), seminal vesicle invasion (P = .07), and biochemical progression (P = .06).

CONCLUSION: Men with smaller prostates had more high-grade cancers and more advanced disease and were at greater risk of progression after RP. These results suggest that prostate size may be an important prognostic variable that should be evaluated for use pre- and postoperatively to predict biochemical progression.

Supported by the Department of Veterans Affairs, National Institutes of Health Grant No. R01CA100938 (W.J.A.), National Institutes of Health Specialized Programs of Research Excellence Grant No. P50 CA92131-01A1 (W.J.A.), the Georgia Cancer Coalition (M.K.T.), Center for Prostate Disease Research grant from the United States Army Medical Research and Materiel Command (C.L.A.), the Department of Defense, Prostate Cancer Research Program Grant No. PC030666 (S.J.F.), and the American Foundation for Urological Disease/American Urological Association Education and Research Scholarship Award (S.J.F.).

The views and opinions of and endorsements by the authors do not reflect those of the US Army or the Department of Defense.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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