Men with anterior-dominant prostate cancer (APCA) have a rate of biochemical failure following radical prostatectomy similar to that of men who have posterior/posterolateral-dominant prostate cancer (PPCA), even though patients with APCA have higher preoperative PSA and higher rates of upgrading at surgery, according to a new study.

“These results suggest that there are no significant differences in clinical outcome in APCA compared to PPCA following prostatectomy, despite the diagnostic challenges of detecting these tumors with conventional prostate biopsy templates,” Sara M. Falzarano, MD, PhD, of the University of Florida in Gainesville, and colleagues reported in Prostate Cancer and Prostatic Diseases.

The study included 132 men with APCA (cases) who were matched to 353 with PPCA (controls) by grade group at surgery, margin status, and pathologic T stage. The entire cohort had a mean follow-up of 23 months and maximum follow-up of 102.6 months.

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Median PSA levels at diagnosis were significantly higher in the APCA than PPCA group (6.4 vs. 5.6 ng/mL). The APCA group also had a significantly higher rate of upgrading at surgery (55.3% vs 42.0%). The groups did not differ significantly in freedom from biochemical failure. The 5-year rates of freedom from biochemical failure were 85.1% in the APCA group and 82.9% in PPCA arm. The study also found no significant difference between the groups with regard to cancer-specific mortality or metastasis.


Falzarano SM, Nyame YA, McKenney JK, et al. Clinicopathologic features and outcomes of anterior-dominant prostate cancer: implications for diagnosis and treatment [published online January 3, 2020]. Prostate Cancer Prostatic Dis.