Index prostate tumors located in the transition zone vs peripheral zone have a lower risk of biochemical recurrence, according to a late-breaking presentation at the American Urological Association’s 2023 annual meeting in Chicago, Illinois.

Shijie Jin, MD, and colleagues from Peking Union Medical College Hospital in Beijing, China conducted a meta-analysis of 14 high-quality studies involving 19,365 patients from several countries treated with radical prostatectomy or radiation therapy. Most studies excluded patients treated with neoadjuvant or adjuvant therapy. The zonal origin of the index prostate tumor was determined by magnetic resonance imaging (MRI) or pathology. Median follow-up was 45.5 months.

Transition zone tumors were significantly associated with a 21% lower risk of prostate cancer biochemical recurrence compared with peripheral zone tumors, Dr Jin reported on behalf of his team. He noted that previous studies found that transition zone tumors tend to be larger volume and have higher PSA, but they also have an earlier T stage and lower Gleason score compared with peripheral zone tumors.

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According to Dr Jin’s team, transition zone tumors might be a different clinical entity. The investigators recommended that zonal origin be incorporated into existing stratification systems to predict BCR.

If MRI finds that the index prostate tumor is located in the transition zone, the patient might be directed towards less aggressive treatment, such as active surveillance, Dr Jin suggested. Focal therapy is another possibility.

Among the meta-analysis’ limitations, definitions of transition and peripheral zones were not standardized. In addition, only 1 of the 16 cohorts included patients who underwent radiation therapy.


Jin S, Wu L, Yan W. Biochemical recurrence of localized prostate cancer originating from the transition versus peripheral zone: a systematic review and meta-analysis. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Presentation LBA02-01.