Abstract
Introduction
Maximum tumor diameter (MTD) on pretreatment magnetic resonance imaging (MRI) has
the potential to further risk stratify for men with prostate cancer (PCa) prior to
definitive local therapy. We aim to evaluate the prognostic impact of radiographic
maximum tumor diameter (MTD) in men with localized prostate cancer.
Patients and Methods
From a single-center retrospective cohort of men receiving definitive treatment for
PCa (radical prostatectomy [RP] or radiotherapy [RT]) with available pretreatment
MRI, we conducted univariable and multivariable Cox proportional-hazards models for
progression using clinical variables including age, NCCN risk group, radiographic
extracapsular extension (ECE), radiographic seminal vesical invasion (SVI), and MTD.
RP and RT cohorts were analyzed separately. Covariates were used in a classification
and regression tree (CART) analysis and progression-free survival was estimated with
the Kaplan-Meier method and groups were compared using log-rank tests.
Results
The cohort included 631 patients (n = 428 RP, n = 203 RT). CART analysis identified
4 prognostic groups for patients treated with RP and 2 prognostic groups in those
treated with RT. In the RP cohort, NCCN low/intermediate risk group patients with
MTD>=15 mm had significantly worse PFS than those with MTD <= 14 mm, and NCCN high-risk
patients with radiographic ECE had significantly worse PFS than those without ECE.
In the RT cohort, PFS was significantly worse in the cohort with MTD >= 23 mm than
those <= 22 mm.
Conclusion
Radiographic MTD may be a useful prognostic factor for patients with locoregional
prostate cancer. This is the first study to illustrate that the importance of pretreatment
tumor size may vary based on treatment modality.
Keywords
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Article info
Publication history
Published online: June 13, 2022
Accepted:
June 11,
2022
Received in revised form:
May 26,
2022
Received:
April 27,
2022
Identification
Copyright
Published by Elsevier Inc.
