Prostate volume predicts risk of grade progression in patients with prostate cancer

Increased prostate volume in patients with low-grade prostate cancer on active surveillance appears to contribute to reduced risks of grade progression (GP) and receipt of definitive prostate cancer treatment, suggests a study.

The authors did a retrospective review of patients with grade group (GG) 1 disease on active surveillance. They used multivariable extended Cox models to explore the associations between prostate volume, 5-alpha reductase inhibitor (5-ARI) use, and the following outcomes: GP on biopsy (to ≥GG 2 and extreme GP to ≥GG 3), receipt of a bladder outlet procedure, and definitive prostate cancer treatment.

A total of 1,938 patients with prostate cancer were analysed. Of these, 14 percent had prostate volumes <30 cc, 73 percent had 30‒80 cc, and 14 percent had >80 cc. Those with prostate volumes >80 cc had greater odds of undergoing bladder outlet procedures (p<0.001).

Multivariable analysis revealed the association between increasing prostate volume and decreased rates of GP (hazard ratio [HR], 0.89, 95 percent confidence interval [CI], 0.85‒0.93; p<0.001) and prostate cancer treatment (HR, 0.91, 95 percent CI, 0.88‒0.95; p<0.001) per 10 cc.

Furthermore, 5-ARI use (per year) correlated with significant GP reductions (HR, 0.80, 95 percent CI, 0.72‒0.89; p<0.001), extreme GP (HR, 0.84, 95 percent CI, 0.73‒0.97; p=0.02), and prostate cancer treatment (HR, 0.53, 95 percent CI, 0.41‒0.67; p<0.001).

“Benign prostatic hyperplasia symptoms can safely be managed on active surveillance, including with 5-ARIs, which were associated with lower risks of GP and progression to definitive treatment in this cohort,” the authors said.