The following is a summary of “Index tumor location affected early biochemical recurrence after radical prostatectomy in patients with negative surgical margin: a retrospective study,” published in the May 2024 issue of Urology by Ogata et al.
Index tumors are recognized as the most aggressive form of prostate cancer, yet their clinical implications remain ambiguous. This study aimed to elucidate the incidence of index tumor locations based on their zonal origin and to determine how these locations influence prognosis following radical prostatectomy in patients with negative surgical margins.
In this single-center, retrospective analysis, researchers evaluated 1,109 consecutive patients who underwent radical prostatectomies. The index tumor was defined as the largest tumor within the prostate gland, and its location was identified using whole-mount sections according to McNeal’s zonal origin classification. Biochemical recurrence (BCR) free survival rates were calculated using the Kaplan–Meier method. Additionally, univariate and multivariate analyses employing the Cox proportional hazards model were conducted to identify predictive factors for early BCR, defined as recurrence within one year post-surgery.
Out of the 1,109 patients, 621 with negative surgical margins who did not receive adjuvant therapy were included in the study. Index tumors were found in the transitional zone in 191 patients (30.8%), the peripheral zone in 399 patients (64.3%), and the central zone in 31 patients (5.0%). During a median follow-up period of 61.7 months, 22 patients (3.5%) experienced early BCR, while 70 (11.2%) encountered overall BCR. Early BCR-free survival rates varied significantly with tumor location: 99.5% in the transitional zone, 95.7% in the peripheral zone, and 83.3% in the central zone. Multivariate analysis revealed that an index tumor located in the central zone was an independent predictor of early BCR in patients with negative surgical margins after radical prostatectomy. Other significant predictors included the prostatectomy pathological grade, index tumor in the peripheral zone, and elevated prostate-specific antigen (PSA) levels.
This study highlights the critical role of index tumor location in predicting early BCR in patients with prostate cancer with negative surgical margins post-radical prostatectomy. Although rare, index tumors in the central zone emerged as the strongest predictor of early BCR. These findings suggest that the location of the index tumor should be carefully considered in postoperative management and may prompt urologists and patients to reassess therapeutic strategies to improve outcomes in prostate cancer treatment.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01499-4
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