Prostatectomy shows an inverse relationship between prostate size and high grade cancer
Previously, radical prostatectomy series have shown an inverse relationship between prostate size and high grade cancer. It was suggested that smaller sized prostates arise in a low androgen environment, which enables development of more aggressive cancer. A recent study by a team of authors from Stanford University School of Medicine in the Journal of Urology, however, shows that small prostate size is not associated with high grade cancer. The authors argue that previous observations are the result of ascertainment bias driven by prostate specific antigen performance.
The study’s authors analyzed 1,404 patients from the Stanford Radical Prostatectomy Database with clinical stage T1c (723) and T2 (681) disease who had surgery between 1988 and 2002 and underwent detailed morphommetric mapping by a single pathologist. They used multivariate linear regression to analyze the effects of age, prostate weight and prostate specific antigen on total and high grade cancer volume and percentage of high grade disease.
Patients who underwent biopsy due to abnormal prostate specific antigen (stage T1c had a prostate weight that was negatively associated with total cancer volume, which is the volume of high grade disease and percentage of high grade disease. For patients who underwent biopsy based on abnormal rectal examination (stage T2), these relationships were not present.
The authors conclude that improved prostate specific antigen performance for high grade disease results in ascertainment bias in patients with T1c disease. For this reason, the relationship between prostate size and high grade disease may be a result of grade dependent performance of prostate specific antigen rather than true tumor biology.
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