Prostate volume and adverse prostate cancer features: Fact not artifact Alberto Briganti a,b,f , Felix K.-H. Chun a,c,f , Nazareno Suardi a,b , Andrea Gallina a,b , Jochen Walz a,c , Markus Graefen d , Shahrokh Shariat a , Andreas Ebersdobler e , Patrizio Rigatti b , Paul Perrotte a , Fred Saad a , Francesco Montorsi b , Hartwig Huland c,d , Pierre I. Karakiewicz a, * a Cancer Prognostics and Health Outcomes Unit, University of Montreal, Canada b Department of Urology, Vita-Salute University, Milan, Italy c Department of Urology, University of Hamburg, Hamburg, Germany d Martini Clinic, Prostate Cancer Center, University of Hamburg, Hamburg, Germany e Department of Pathology, University of Hamburg, Hamburg, Germany ARTICLE INFO Article history: Received 17 August 2007 Received in revised form 13 September 2007 Accepted 20 September 2007 Available online 8 November 2007 Keywords: Prostate cancer Prostate volume High grade prostate cancer ABSTRACT 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), sem- inal 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. Ó 2007 Elsevier Ltd. All rights reserved. 1. Introduction Within the Prostate Cancer Prevention Trial (PCPT), the effect of finasteride resulted in 24% prostate size reduction and in 50% decrease in circulating serum prostate specific antigen (PSA). 1 Finasteride also reduced prostate cancer (PCa) preva- lence by 25%. Concurrently, a higher rate of Gleason sum 7-10 PCa (37.0%) was seen in finasteride-exposed men, rela- tive to the placebo group (22.2%, p < 0.001). This increase in high grade PCa (HGPCa) stirred many controversies. 2 Central in this debate is whether the increase in HGPCa found in fin- asteride exposed and size-reduced prostate glands is related 0959-8049/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2007.09.022 * Corresponding author: Address: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058, rue St-Dennis, Montreal, Quebec, Canada H2X 3J4. Tel.: +001 514 890 8000 35336; fax: +001 514 227 5103. E-mail address: pierre.karakiewicz@umontreal.ca (P.I. Karakiewicz). f Both authors contributed equally to the manuscript. EUROPEAN JOURNAL OF CANCER 43 (2007) 2669 – 2677 available at www.sciencedirect.com journal homepage: www.ejconline.com