effect of tumor volume on BCR for T3a

We're still trying to decide if husband should go with ART in January. I keep asking doctors if his high tumor volume (60%) increases his risk of BCR...none of the doctors have payed much attention to that. Then I found this study in latest issue of Uro Today. Relevant portions below:

The 5-year recurrence-free survival rates of pT3a diseases with negative surgical margin were 85.2% for percent tumor volume ≤ 12% and 57.7% for percent tumor volume >12% (P < 0.001). Patients with pT3a with negative surgical margins and percent tumor volume >12% showed comparable 5-year recurrence-free survival rate compared with those with pT3a with positive surgical margin (57.7% vs 57.6%; P = 0.763).

CONCLUSIONS: Despite having less impact on recurrence than other clinicopathological variables in pT3-T4 prostate cancer, percent tumor volume can further improve recurrence risk stratification in pT3a diseases with negative surgical margins.

Might help someone else going through the decision-making process.

You have certainly found something to talk to his doctors about while they help him decide. Good doctors are always glad to talk about new research.

On observation: His prostate was fairly small so 60% would still not be a giant tumor -- but I have no idea if that matters.

I too noticed the small prostate. His PSA density was almost 3x the average, which is a risk factor for biochemical recurrence free survival. Small prostates can be tricky with surgery especially if the tumor is near the apex because it can be challenging to dig the capsule out of the prostate bed. Bladder neck sparing, nerve sparing and urethral preservation can also be challenging with a small prostate, depending on where the tumor is.

The EPE is a risk factor, but on the positive side, the Gleason score was downgraded to 3+4 (with no mention of any tertiary 5). PSA so far looks good. I hope it stays undetectable.

- Allen