Prostate Total Tumor Extent Versus Index Tumor Extent - Which Is Predictive Of Biochemical Recurrence Following Radical Prostatectomy?

Purpose: It is controversial whether tumor extent in radical prostatectomies predicts biochemical recurrence following surgery. We compared the predictive value of total tumor extent vs dominant nodule (index tumor) extent. Materials and Methods: A mean of 32 paraffin blocks was processed from prostate surgical specimens step sectioned at 3 to 5 mm intervals from 300 patients treated with radical retropubic prostatectomy. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semiquantitative point count method. Dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer in the quadrants. Time to biochemical recurrence was analyzed by Kaplan-Meier product limit analysis. Prediction of shorter time to biochemical recurrence was determined by univariate and multivariate Cox proportional hazards models. Results: Except for age and race, total and index tumor extent was significantly associated with higher preoperative prostate specific antigen, clinical stage T2, pathological stage greater than T2, positive surgical margins and higher radical prostatectomy Gleason score. Total and index tumor extent was significantly associated with time to biochemical recurrence in Kaplan-Meier estimates. Total and index tumor extent significantly predicted shorter time to biochemical recurrence on univariate analysis but only index tumor extent was an independent predictor of time to biochemical recurrence on multivariate analysis. Conclusions: The study indicates that any tumor extent estimate in surgical specimens should be related to the dominant nodule (index tumor) and not to total tumor extent. © 2013 American Urological Association Education and Research, Inc.189199104Antunes, A.A., Srougi, M., Dall'oglio, M.F., Preoperative determination of prostate cancer tumor volume: Analysis through biopsy fragments (2007) Int Braz J Urol, 33, p. 477Briganti, A., Chun, F.K., Hutterer, G.C., Systematic assessment of the ability of the number and percentage of positive biopsy cores to predict pathologic stage and biochemical recurrence after radical prostatectomy (2007) Eur Urol, 52, p. 733Brimo, F., Vollmer, R.T., Corcos, J., Prognostic value of various morphometric measurements of tumor extent in prostate needle core tissue (2008) Histopathology, 53, p. 177D'Amico, A.W., Whittington, R., Malkowicz, S.B., The combination of preoperative prostate specific antigen and postoperative pathological findings to predict prostate specific antigen outcome in clinically localized prostate cancer (1998) J Urol, 160, p. 2096Epstein, J.I., Potter, S.R., The pathological interpretation and significance of prostate needle biopsy findings: Implications and current controversies (2001) J Urol, 166, p. 402Bismar, T.A., Ewis, Jr.J.S., Vollmer, R.T., Multiple measures of carcinoma extent versus perineural invasion in prostate needle biopsy tissue in prediction of pathologic stage in a screening population (2003) Am J Surg Pathol, 27, p. 432Quintal, M.M., Meirelles, L.R., Freitas, L.L., Various morphometric measurements of cancer extent on needle prostatic biopsies: Which is predictive of pathologic stage and biochemical recurrence following radical prostatectomy? 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The Rio Dourado Intrusive Suite - 1.88 Ga A-type Granite - Southeastern Amazonian Craton - Mato Grosso - Brazil [a Suíte Intrusiva Rio Dourado - Um Granito Tipo A De 1,88 Ga - Sudeste Do Craton Amazônico - Mato Grosso - Brasil]

The Rio Dourado Intrusive Suite (RDIS) is composed of granitic rocks which are exposed in the southeastern Amazon Craton, Central Amazon Province. These granites intruded into the Paleoproterozoic granites of the Vila Rica Intrusive Suite. The predominantly pyroclastic felsic volcanic rocks of the Iriri Group are coeval and spatially associated with the intrusive granites. Petrographic studies allow us to divide the Rio Dourado granites into: biotite granites, amphibole-bearing biotite granites and granophyric granites. Modal compositions range from monzo to syenogranites. The oxidized A-type granite is characterized by FeO/FeO+MgO ranging from 0.8 - 0.95, high contents of FeOT and low contents of CaO, as well as peraluminous composition. In the tectonic discrimination diagrams, samples of these granites plot in the post-collisional field. REE patterns show enrichment in the LREE relative to HREE and negative Eu anomalies. Negative anomalies of Ta and Nb, as well as depletion in the HREE, features which are typical of A-type granites of post-collisional settings, are observed in multi-element diagrams,. Ce, Yb, Nb and Ga contents are transitional between those of A2 and A1-type granites. U-Pb zircon dating by TIMS yielded an age of 1876 ± 39, whereas negative values of εNd (-3 to -10) and model ages (TDM) between 2.6 and 2.8 Ga indicate it was formed by re-melting of older (possibly Archean) crust.1117593Almeida, M.E., Macambira, M.J.B., Scheller, T., Içana intrusive suíte: Age 207Pb/ 206Pb (zircon evaporation) of muscovite-bearing granite, Amazonas State, Brazil (1997) South-American Symposium on Isotope Geology, pp. 31-33. , 1., 1997, Campos do Jordão. 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Geochemistry and isotopic evidence (2009) Journal of South American Earth Sciences, 27, pp. 11-23Barros, M.A.S., Padilha, R.A., Rubert, R.R., Pimentel, M.M., Chemale Jr., F., Iriri volcanism and Rio Dourado Granite: A-type Paleoproterozoic Magmatism in northeastern Mato Grosso - Brazil (2006) Symposium on Magmatism, Crustal Evolution, and Metallogenesis of the Amazonian Craton/Workshop on A-Type Granites and Related Rocks Through Time (IGCP 510), 2006, p. 39. , Belém. Abstract volume and Field Trips Guide... Belém: PRONEXUFPA/SBG-NO, -39Barros, M.A.S., Pimentel, M.M., Dantas, E.L., Padilha, R.A., Geoquímica e dados isotópicos da suíte intrusiva vila rica e suíte intrusiva rio dourado - Mato Grosso, área Xingú - Província Amazônia central - Sul do Craton Amazônico (2008) Simpósio de Vulcanismo e Ambientes Associados, , 4. 2008, Foz do Iguaçu. Anais... 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