Prostate volume and adverse prostate cancer features: Fact not artifact

Purpose: A recent prostate cancer finasteride chemoprevention trial showed a higher rate of sextant biopsy-detected high grade prostate cancer (HGPCa) in finasteride exposed men, whose prostates were significantly smaller than those of controls. We investigated the association between prostate size and prostate cancer grade and stage in a large (n = 3412) single center radical prostatectomy cohort, which was unexposed to any form of hormonal manipulation. Methods: Logistic regression models were used. Results: Small prostates were associated with higher rate of HGPCa at biopsy and at radical prostatectomy (both p <0.001), with higher rate of extracapsular extension (p <0.001), seminal vesicle invasion (p <0.001) and with tumor volume >3.4cc, after accounting for age, PSA, clinical stage and year of surgery. Conclusions: Our findings demonstrate that prostate cancers located in small glands are fundamentally more aggressive than those located within larger glands. In consequence, prostate cancer detection and treatment strategies should account for prostate volume.