Prognostic Significance of Multifocal Tumor in Radical Prostatectomy

Purpose: We investigate the impact of tumor multifocality on the biochemical recurrence rate after radical prostatectomy. Materials and Methods: Data was collected from 525 patients who underwent radical prostatectomy for clinically localized prostate cancer from 2003 to 2007. We evaluated the potential associations of multifocality with various clinical and pathologic factors. The ability to predict extra-capsular extension (ECE) was tested by logistic regression models, whereas biochemical recurrence (BCR) was assessed via Kaplan-Meier analyses and Cox-hazard regression models. The BCR was defined as a level of serum prostate-specific antigen (PSA) of 0.2ng/ml or greater on consecutive evaluations. Results: Multifocality was observed to be significantly associated with the presence of a high grade Gleason pattern (p=0.014), the pT stage (p＜ 0.001), ECE (p=0.005) and a positive surgical margin (PSM) (p=0.019). Moreover, it was the independent predictor of ECE on multivariate logistic regression analyses (p=0.039). However, although multifocality had a significant influence on biochemical recurrence on the Kaplan-Meier analyses (log rank test, p=0.019), only the PSA level and the Gleason score were significant predictors of BCR on the multivariated Cox-hazard analyses. Conclusions: Although multifocality was associated with adverse pathologic features, it had no significant effect on biochemical recurrence on the multivariated cox-hazard analyses