Adult UrologyProstate cancer detection: relationship to prostate size
Section snippets
Processing, digitization of prostates, and volume determination
One hundred eighty radical prostatectomy specimens were processed as whole mounts, as previously described.5 Each gland was weighed. In our previous report, we established that gland weight was equivalent to gland volume. The prostate specimens were then serially sectioned at 4-mm intervals. The apical and the base (bladder neck) margins of resection were examined by perpendicular sections and were not represented in the reconstructed computer models. Coordinates for each step section of the
Distribution of prostate and cancer volume
For these 180 actual cases, median prostate weight was 37.7 g (range 17.0 to 154.0). Median total tumor volume for these cases was 1.39 cc (range 0.01 to 19.1). The median volume of the peripheral zone cancers (when present) was 0.80 cc (range 0.01 to 4.73). The median volume of the transition zone cancers (when present) was 0.43 cc (range 0.001 to 11.08).
Small-volume cancers were more prevalent in large glands (Table I, P = 0.03). Of 40 prostates greater than 50 g, 13 (33%) had a total cancer
Comment
In two large studies, the cancer detection rate was clearly demonstrated to be lower in large prostates. Both Uzzo et al.2 and Karakiewicz et al.3 concluded that their observations were most likely due to the undersampling of large glands by sextant biopsy. On the surface, our observations support this conclusion. However, if the lower rate of cancer detection in larger prostates is due to sampling of a smaller relative volume, it would be expected that larger volume cancers would be
Conclusions
The observed lower cancer detection rate in large glands is a result of the higher proportion of small-volume cancers in these glands. Large prostates are more likely to be biopsied because of an elevated PSA value resulting from benign elements of the gland and not from a significant cancer. Increasing the number of cores solely to compensate for increased prostate size risks a disproportionate increase in the detection of small-volume tumors with a low clinical likelihood of progression.
References (15)
- et al.
The influence of prostate size on cancer detection
Urology
(1995) - et al.
Outcome of sextant biopsy according to gland volume
Urology
(1997) - et al.
Optimization of prostate biopsies using computer based analysis
J Urol
(1997) - et al.
Tumor volume and prostate-specific antigenimplications for early detection and defining a window of curability
J Urol
(1995) - et al.
Influence of noncancerous prostatic tissue volume on prostate-specific antigen
Urology
(1998) - et al.
Distinguishing clinically important from unimportant prostate cancers before treatmentvalue of systematic biopsies
J Urol
(1996) - et al.
Diagnosis of “suspicious for malignancy” in prostate biopsiespredictive value for cancer
Urology
(1998)
Cited by (83)
Deep Learning Network for Segmentation of the Prostate Gland With Median Lobe Enlargement in T2-weighted MR Images: Comparison With Manual Segmentation Method
2022, Current Problems in Diagnostic RadiologyBiparametric prostate MRI and clinical indicators predict clinically significant prostate cancer in men with “gray zone” PSA levels
2020, European Journal of RadiologyPredictive factors of prostate cancer diagnosis with PSA 4.0–10.0 ng/ml in a multi-ethnic Asian population, Malaysia
2020, Asian Journal of SurgeryThe role of quantitative MRI-based prostate zonal parameters in predicting clinically significant prostate cancer: A U.S. cohort
2023, Canadian Urological Association JournalThe Application of Biopsy Density in Transperineal Templated-Guided Biopsy Patients With PI-RADS<3
2022, Frontiers in Oncology