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.
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.
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.
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- Cancer statistics, 2021.CA Cancer J Clin. 2021; 71: 7-33
- The prostate testing for cancer and treatment (ProtecT) study: what have we learnt?.BJU Int. 2016; 118: 843https://doi.org/10.1111/bju.13699
- Cancer control with radical prostatectomy alone in 1,000 consecutive patients.J Urol. 2002; 167 (Pt 1): 528-534https://doi.org/10.1097/00005392-200202000-00018
- Biochemical recurrence after radical prostatectomy: what does it mean?.International Braz J Urol. 2018; 44: 14-21
- Use of different definitions of biochemical failure after external beam radiotherapy changes conclusions about relative treatment efficacy for localized prostate cancer.Urology. 2006; 68: 593-598
- Salvage reirradiation for local prostate cancer recurrence after radiation therapy. For who? When? How?.Cancer/Radiothérapie. 2019; 23: 541-558
- Differences in risk factors for biochemical recurrence after radical prostatectomy stratified by the degree of obesity: Focused on surgical methods.Scientific Reports. 2020; 10: 1-8
- Impact of Gleason score on biochemical recurrence free survival after radical prostatectomy with positive surgical margins.Prog Urol. 2017; 27: 467-473
- Long-term data on the survival of patients with prostate cancer treated with radical prostatectomy in the prostate-specific antigen era.BJU Int. 2010; 106: 37-43
- Maximum tumor diameter is an independent predictor of prostate-specific antigen recurrence in prostate cancer.Mod Pathol. 2005; 18: 886-890
- Larger maximum tumor diameter at radical prostatectomy is associated with increased biochemical failure, metastasis, and death from prostate cancer after salvage radiation for prostate cancer.Int. J. Radiat. Oncol. Biol. Phys. 2013; 87: 275-281
- Prognostic value of pretreatment mri in patients with prostate cancer treated with radiation therapy: a systematic review and meta-analysis.AJR Am J Roentgenol. 2020; 214: 597-604https://doi.org/10.2214/AJR.19.21836
- Focal boost to the intraprostatic tumor in external beam radiotherapy for patients with localized prostate cancer: results from the FLAME randomized phase III trial.J Clin Oncol. 2021; 39: 787-796
- Classification and Regression Trees.Routledge, New York2017
- Version Version Release 14.StataCorp, LP2015
- Updated 17 September 2021. Available online: https://www.ncbi.nlm.nih.gov/books/NBK470550/ (accessed on 28 November 2021).
- MRI of the prostate: interobserver agreement compared with histopathologic outcome after radical prostatectomy.Eur J Radiol. 2012; 81: 456-460https://doi.org/10.1016/j.ejrad.2010.12.076
- Maximal tumor diameter and the risk of PSA failure in men with specimen-confined prostate cancer.Urology. 2005; 66: 1024-1028
- Maximum tumor diameter: a simple independent predictor for biochemical recurrence after radical prostatectomy.Prostate Cancer Prostatic Dis. 2010; 13: 244-247
- The effect of maximum tumor diameter by MRI on disease control in intermediate and high-risk prostate cancer patients treated with brachytherapy boost.Clin Genitourin Cancer. 2022; 20: e68-74
- Predicting pathological tumor size in prostate cancer based on multiparametric prostate magnetic resonance imaging and preoperative findings.J Urol. 2021; 205: 444-451https://doi.org/10.1097/JU.0000000000001389
- Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use.Eur Urol. 2016; 69: 41-49https://doi.org/10.1016/j.eururo.2015.08.038
- Prognostic implications of multiparametric magnetic resonance imaging and concomitant systematic biopsy in predicting biochemical recurrence after radical prostatectomy in prostate cancer patients diagnosed with magnetic resonance imaging-targeted biopsy.Eur Urol Oncol. 2020; 3: 739-747https://doi.org/10.1016/j.euo.2020.07.008
- The prognostic association of prostate MRI PI-RADS v2 assessment category and risk of biochemical recurrence after definitive local therapy for prostate cancer: a systematic review and meta-analysis.J Urol. 2021; 206: 507-516https://doi.org/10.1097/JU.0000000000001821
- PI-RADS Score is Associated With Biochemical Control and Distant Metastasis in Men With Intermediate-Risk and High-Risk Prostate Cancer Treated With Radiation Therapy.Urologic Oncology: Seminars and Original Investigations. 2020; 38 (Elsevier): 600-e1
- Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naive patients.BJU Int. 2017; 119: 225-233https://doi.org/10.1111/bju.13465
Published online: June 13, 2022
Accepted: June 11, 2022
Received in revised form: May 26, 2022
Received: April 27, 2022
Published by Elsevier Inc.