No AccessJournal of UrologyAdult Urology1 Jan 2011A Critical Analysis of the Tumor Volume Threshold for Clinically Insignificant Prostate Cancer Using a Data Set of a Randomized Screening Trial Tineke Wolters, Monique J. Roobol, Pim J. van Leeuwen, Roderick C.N. van den Bergh, Robert F. Hoedemaeker, Geert J.L.H. van Leenders, Fritz H. Schröder, and Theodorus H. van der Kwast Tineke WoltersTineke Wolters Department of Pathology, Erasmus MC Rotterdam, The Netherlands Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author , Monique J. RoobolMonique J. Roobol Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author , Pim J. van LeeuwenPim J. van Leeuwen Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author , Roderick C.N. van den BerghRoderick C.N. van den Bergh Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author , Robert F. HoedemaekerRobert F. Hoedemaeker Department of Pathology, Sint Franciscus Gasthuis Rotterdam, The Netherlands More articles by this author , Geert J.L.H. van LeendersGeert J.L.H. van Leenders Department of Pathology, Erasmus MC Rotterdam, The Netherlands More articles by this author , Fritz H. SchröderFritz H. Schröder Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author , and Theodorus H. van der KwastTheodorus H. van der Kwast Department of Pathology, Erasmus MC Rotterdam, The Netherlands Department of Pathology, University Health Network, Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.08.082AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The identification of clinically insignificant prostate cancer could help avoid overtreatment. Current criteria for insignificant prostate cancer use a tumor volume threshold of less than 0.5 ml for the index tumor. In this study we reassess this tumor volume threshold for clinically insignificant prostate cancer using an independent data set. Materials and Methods: The rate of insignificant prostate cancer was calculated by modeling lifetime risk estimates of prostate cancer diagnosis in screened and nonscreened participants in a randomized prostate cancer screening trial. Using lifetime risk estimates 50.8% of screen detected prostate cancer was calculated to be clinically insignificant and the 49.2% largest tumor volume of 325 prostatectomy specimens was used to determine the threshold tumor volume for insignificant prostate cancer. Because stage and grade represent the strongest determinants of cancer aggressiveness, we also calculated the tumor volume threshold for insignificant cancer after the selection of patients with organ confined prostate cancer without Gleason pattern 4/5. The analyses were performed for total tumor volume and for index tumor volume. Results: The minimum threshold tumor volume of the index tumor and total tumor was 0.55 and 0.70 ml, respectively. After accounting for tumor stage and grade we obtained a threshold volume for the index tumor and total tumor of 1.3 and 2.5 ml, respectively. Conclusions: We confirmed the original value of the index tumor volume threshold of 0.5 ml for insignificant prostate cancer, and we demonstrated that clinically insignificant prostate cancer may include index Gleason score 6, pT2 tumors with volumes up to at least 1.3 ml. These results suggest a reconsideration of current methods and nomograms used for pretreatment risk assessment. 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Volume 185Issue 1January 2011Page: 121-125 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordstumor burdenearly detection of cancerprostatic neoplasmsMetricsAuthor Information Tineke Wolters Department of Pathology, Erasmus MC Rotterdam, The Netherlands Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author Monique J. Roobol Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author Pim J. van Leeuwen Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author Roderick C.N. van den Bergh Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author Robert F. Hoedemaeker Department of Pathology, Sint Franciscus Gasthuis Rotterdam, The Netherlands More articles by this author Geert J.L.H. van Leenders Department of Pathology, Erasmus MC Rotterdam, The Netherlands More articles by this author Fritz H. Schröder Urology, Erasmus MC Rotterdam, The Netherlands More articles by this author Theodorus H. van der Kwast Department of Pathology, Erasmus MC Rotterdam, The Netherlands Department of Pathology, University Health Network, Toronto, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...