TUMOR VOLUME DIGITAL IMAGE ANALYSIS SOFTWARE AND PROGNOSTIC FACTORS1814

therapy. Ultimately this may be achieved by strati-fying patients with questionable or minimal PSMsand directing them to adjuvant therapy or observa-tion based on objective tumor volume rather than onsubjective observations alone. This requires further

study and data from other centers.

REFERENCES

EDITORIAL COMMENT

ACKNOWLEDGMENTS

Professor Ronnie Cohen provided expertise. SophieRogers provided statistical advice and support. T.Nottle, D. Clouston and A. Ryan, TissuPath, as-

sisted with the study.

1. Wingo PA, Ries LA, Parker SL et al: Long-termcancer patient survival in the United States. Can-cer Epidemiol Biomarkers Prev 1998; 7: 271.

2. Watson RB, Civantos F and Soloway MS: Positivesurgical margins with radical prostatectomy: de-tailed pathological analysis and prognosis. Urol-ogy 1996; 48: 80.

3. McNeal JE: Origin and development of carcinomain the prostate. Cancer 1969; 23: 24.

4. Stamey TA, Freiha FS, McNeal JE et al: Localizedprostate cancer. Relationship of tumor volume toclinical significance for treatment of prostatecancer. Cancer 1993; 71: 933.

5. Stamey TA, McNeal JE, Yemoto CM et al: Bio-logical determinants of cancer progression inmen with prostate cancer. JAMA 1999; 281:1395.

6. Vollmer RT: Percentage of tumor in prostatec-tomy specimens: a study of American veterans.Am J Clin Pathol 2009; 131: 86.

7. Stamey TA, McNeal JE, Freiha FS et al: Morpho-metric and clinical studies on 68 consecutiveradical prostatectomies. J Urol 1988; 139: 1235.

8. McNeal JE, Villers AA, Redwine EA et al: Histo-logic differentiation, cancer volume, and pelviclymph node metastasis in adenocarcinoma of theprostate. Cancer 1990; 66: 1225.

9. McNeal JE, Villers AA, Redwine EA et al: Cap-

for natural history and treatment. Am J SurgPathol 1990; 14: 240.

10. Tefilli MV, Gheiler EL, Tiguert R et al: ShouldGleason score 7 prostate cancer be considered aunique grade category? Urology 1999; 53: 372.

11. Pierorazio PM, Kinnaman MD, Wosnitzer MS etal: Prostate volume and pathologic prostate can-cer outcomes after radical prostatectomy. Urol-ogy 2007; 70: 696.

12. McNeal JE: Cancer volume and site of origin ofadenocarcinoma in the prostate: relationship tolocal and distant spread. Hum Pathol 1992; 23:258.

13. Freiha F and Redwine E: Volume of detecteddisease and ability to effect cure by radical pros-tatectomy. World J Urol 1989; 7: 45.

14. Sakr WA, Tefilli MV, Grignon DJ et al: Gleasonscore 7 prostate cancer: a heterogeneous entity?Correlation with pathologic parameters and dis-ease-free survival. Urology 2000; 56: 730.

15. Eastham JA, Kattan MW, Riedel E et al: Varia-tions among individual surgeons in the rate ofpositive surgical margins in radical prostatectomyspecimens. J Urol 2003; 170: 2292.

16. Swindle P, Eastham JA, Ohori M et al: Do mar-gins matter? The prognostic significance of pos-itive surgical margins in radical prostatectomyspecimens. J Urol 2008; 179: S47.

17. Vickers AJ, Bianco FJ, Serio AM et al: The sur-

after radical prostatectomy. J Natl Cancer Inst2007; 99: 1171.

18. Boorjian SA and Blute ML: Surgical managementof high risk prostate cancer: the Mayo Clinicexperience. Urol Oncol 2008; 26: 530.

19. Evans AJ, Henry PC, Van der Kwast TH et al:Interobserver variability between expert urologicpathologists for extraprostatic extension and sur-gical margin status in radical prostatectomy spec-imens. Am J Surg Pathol 2008; 32: 1503.

20. Hall GS, Kramer CE and Epstein JI: Evaluation ofradical prostatectomy specimens. A comparativeanalysis of sampling methods. Am J Surg Pathol1992; 16: 315.

21. Epstein JI, Pizov G and Walsh PC: Correlation ofpathologic findings with progression after radicalretropubic prostatectomy. Cancer 1993; 71: 3582.

22. Grossfeld GD, Tigrani VS, Nudell D et al: Man-agement of a positive surgical margin after rad-ical prostatectomy: decision analysis. J Urol2000; 164: 93.

23. Swanson GP, Hussey MA, Tangen CM et al:Predominant treatment failure in postprostatec-tomy patients is local: analysis of patterns oftreatment failure in SWOG 8794. J Clin Oncol2007; 25: 2225.

24. Bolla M, van Poppel H, Collette L et al: Postop-erative radiotherapy after radical prostatectomy:a randomised controlled trial (EORTC trial 22911).

sular penetration in prostate cancer. Significance gical learning curve for prostate cancer control Lancet 2005; 366: 572.

For almost every cancer in every organ the mass inan important variable but in PC cases the impor-tance of tumor volume is controversial. In fact, mea-sures of tumor volume in prostatectomy specimensare often omitted from pathology reports. These au-thors again show that PTV is significantly related toother important prognosticators, such as PSMs andpathological stage. As measured by sophisticatedimaging software, tumor volume was significantlyassociated with PSMs, which was true for tumorvolume expressed in cc or as a percent of the pros-

tate gland. Thus, this study shows that tumor vol-ume is not a statistically independent prognosticfactor. We must wait for the author followup studyto see whether tumor volume is more or less impor-tant than other prognostic factors to predict tumor-free and overall survival.

Robin T. Vollmer

Department of Surgical PathologyVeterans Affairs Medical Center

Durham, North Carolina