Small prostate size could indicate more aggressive prostate cancer
Tags: aggressive prostate cancer, ash tewari, ashtewari publications, davinci prostatectomy, institute of prostate cancer, lefrak center for robotic surgery, localized prostate cancer, medwire, new research, nycrobotics, Prostate Cancer, prostate cancer research, prostate cancer surgery, prostate cancer treatment, radical prostatectomy, robotic prostate cancer surgery, robotic prostatectomy, robotic surgery, robotics, small prostates, urology research
Reproduced from Medwire News. Author: Sarah Guy
Prostate cancer patients with small prostates have worse histopathological outcomes than their counterparts with large prostates, report US researchers who hope that a small prostate will act as a “red flag” for treatment with surgery rather than observation.
Specifically, small prostates (<40 cm3) – which are common in young men – can indicate a higher Gleason score at biopsy, a higher pathological stage at surgery, and a greater incidence of positive surgical margins (PSMs) at surgery, than large prostates (>70 cm3).
Study author Ashutosh Tewari (Weill Cornell Medical College, New York) explained to MedWire News that in a smaller prostate there is less barrier tissue to prevent the cancer spreading beyond the prostate into other tissues, which could impact the treatment patients are offered.
“If the prostate is very big, there normally is much more barrier tissue around the cancer and you have enough time to wait it out and try to do things which can be relatively non-invasive,” he said.
Also speaking to MedWire News, fellow researcher Prasanna Sooriakumaran added that young men or men with small prostates may be better served by treatment with surgery rather than active surveillance or watchful waiting policies.
Tewari, Sooriakumaran, and team investigated the relationship between oncologically important histopathological variables and prostate volume in a cohort of 2207 men who underwent robotic-assisted radical prostatectomy.
Patients with small prostates were younger and had lower prostate-specific antigen levels than those with large prostates.
However, a small prostate also indicated a worse Gleason score after surgery, a greater tumor volume, more evidence of extraprostatic extension, and a greater incidence of PSMs, at 11.5% versus 5.6% for prostates less than 40 cm3 and greater than 70 cm3, respectively.
“You have a very time-sensitive duration/window of opportunity in which you can take the entire organ out and not let cancer cells escape the prostate,” said Tewari.
“So that needs to be factored into the decision-making process, because if cancer has indeed gone out of the smaller prostate by the time you intervene, you’ve lost an opportunity to cure,” he added.
“We want small prostate volume to act as a red flag in terms of it suggesting these patients need something more actively done about it,” Sooriakumaran concluded.