Here's a study you might find of interest:
"Percent tumor volume predicts biochemical recurrence after radical prostatectomy: multi-institutional data analysis" www.ncbi.nlm.nih.gov/pubmed/21818571
To investigate the prognostic significance of percent tumor volume (PTV) in relation to the surgical margin status in men with prostate cancer after radical prostatectomy (RP).
Clinical and pathological data from 1,567 patients treated with RP only between 1995 and 2007 at participating institutions were reviewed. PTV was determined by the sum of all visually estimated tumor foci on every section. Biochemical recurrence (BCR) was defined as 2 consecutive increases in prostate-specific antigen (PSA) > 0.2 ng/ml and various clinicopathological variables were tested for prognostication of recurrence-free survival.
Serum PSA at surgery was 12.5 ± 16.8 ng/ml and pathological stage was T2 in 899 (57.4%) patients. Surgical Gleason score was 7 in 842 patients (53.7%), higher than 7 in 250 (16%) patients, and in 32% of the patients, surgical margin was positive. Mean PTV was 15.7% and demonstrated a significant positive correlation with serum PSA, all pathological variables and BCR. On multivariate analysis, preoperative PSA (p = 0.012), surgical Gleason score (p < 0.0001, HR 2.183, 95% CI 1.778-2.681), and PTV (≤5, 5.1-15, >15%; p < 0.0001, HR 1.393, 95% CI 1.183-1.641) were independently prognostic of recurrence-free survival. Pathological stage demonstrated a significant relationship with BCR but was not independently prognostic in the multivariate model.
In men with prostate cancer, preoperative PSA, surgical Gleason score, and PTV are independent predictors of recurrence-free survival after RP.
"Tumor volume does not predict for biochemical recurrence after radical prostatectomy in patients with surgical Gleason score 6 or less prostate cancer" www.ncbi.nlm.nih.gov/pubmed/17826492
No consensus exists regarding the prognostic value of tumor volume (TV) in predicting biochemical recurrence (BCR) of prostate cancer, especially late in the prostate-specific antigen (PSA) era. We assessed this relationship in a large cohort of patients treated at one institution with standardized pathologic assessment from 1998 to 2005.
Data were collected for 1833 patients undergoing radical prostatectomy for clinically localized prostate cancer since 1998. Patients receiving neoadjuvant or adjuvant therapy or with node-positive disease were excluded. Along with the routine pathologic assessment, TV was prospectively assessed in all specimens. BCR was defined as two consecutive PSA levels of 0.2 ng/mL or one PSA level of greater than 0.2 ng/mL.
Although a larger TV correlated with lower rates of biochemical relapse-free survival in patients with a surgical Gleason score of 7 (P <0.0001) and surgical Gleason score of 8 or greater (P = 0.0459), the biochemical relapse-free survival rate at 4 years for low, medium, and extensive surgical Gleason score 6 or less tumors was 95%, 96%, and 97%, respectively (P = 0.65). In a multivariate model, including TV, initial PSA, EPE, seminal vesicle invasion, and surgical Gleason score, the TV predicted for BCR (P = 0.0176).
The results of this large study suggest that a large TV is an independent predictor of BCR in patients with tumors of specimen Gleason score 7 or higher. In contrast, most grade 6 tumors will be organ confined, even if of high volume, and TV will not predict for BCR in these patients.
Also, it isn't too late to have another lab review your biopsy slides for a second opinion.
Age 59 Gleason 9
1/10 PSA 14.7
5/10 Bx: Gleason 3+4
8/4/2010 RRP: Gleason 4+5; Positive Margins, PNI
Incontinence: N/A; ED: 70%
Until 4/11, PSA <.01; 4/11: .01; 6/11: .03
ADT3 started 7/20; WPRT started 8/22
Post Edited (Riviere) : 10/14/2011 8:25:37 AM (GMT-6)