ARE THE EFFORTS TOWARDS PROSTATE CANCER EARLY DETECTION ASSOCIATED WITH A SIGNIFICANT
REDUCTION IN TUMOR VOLUME? AN ANALYSIS STRATIFIED ACCORDING TO RISK CATEGORIES
Giovanni La Croce, Suardi Nazareno, Andrea Gallina, Umberto Capitanio, Nicola Fossati, Rayan Matloob, Andrea Salonia, Roberto
Bertini, Marco Moschini, Milan, Italy, Rocco Damiano, Francesco Cantiello, Catanzaro, Italy, Massimo Freschi, Claudio Doglioni,
Giorgio Guazzoni, Francesco Montorsi, Alberto Briganti, Milan, Italy
INTRODUCTION AND OBJECTIVES: The introduction of early detection policies in prostate cancer (PCa) has resulted in a
significant increase in the number of diagnoses. However, whether the impact of such policies have affected tumor volume in radical
prostatectomy (RP) specimens is unknown. We thus tested the variation in tumor volume over time in a large population of patients
treated with RP stratified according to PCa characteristics
METHODS: We analyzed prospectively collected data of 2308 patients affected by PCa and treated with RP between 2006 and 2012
in a single tertiary care referral center. Patients treated with neo-adjuvant hormonal therapy were excluded from the study. Tumor
volumes were calculated by visual inspection. Patients were stratified in three risk groups: low (PSA < 10 ng/ml, clinical stage T1c
and Gleason score 6 or less), high (PSA >20 ng/ml, clinical stage T3 or Gleason score 8-10) and intermediate (all the remaining). The
analyses targeted the variation of tumor volume over time within each risk group. Linear regression analyses were used to investigate
the relation between date of surgery and tumor volume in each risk group.
RESULTS: Mean and median age at diagnosis was 63.9 and Mean and median tumor volume at RP was 4.8 and 2.85 ml, respectively
(range: 0.12-68.6). Overall, 40.2, 43.7 and 16.2% of patients were affected by low, intermediate and high risk PCa, respectively. Mean
tumor volume was 2.82, 4.66 and 10.08 ml in low, intermediate and low risk patients, respectively (p<0.001). When linear regression
analyses targeted the association between date of surgery and tumor volume, after adjusting for patient age, no significant trend in
tumor volume reduction over time was seen (β=-0.01; p=0.46). However, when the same analyses were repeated in each risk group, a
significant reduction in tumor volume over time was seen in low (β=-0.79; p=0.01) and intermediate risk patients (β=-0.08;p=0.01),
while in high risk patients no tumor volume reduction was observed (β=0.05; p=0.3)
DISCUSSION: The efforts towards early stage PCa detection has resulted in a significant reduction of tumor volume in patients
diagnosed with low and intermediate PCa. However, a non negligible proportion of these patients might not even need active
treatment. Conversely, such reduction was not valid for patients affected by high risk PCa where local tumor burden remained stable
over time
CONCLUSIONS: Efforts should be made to decrease tumor burden specifically in those patients where active treatment has the
highest impact in order to increase patient outcome