Raison N, Servian P, Patel A, et al. - In high risk prostate cancer, oncological outcomes are independently predicted by pathological tumor volume (TV). Pathological TV failed to add significant prognostic value in combination with established variables. However, the option of precise TV measurement on multiparametric MRI raises the likelihood of employing TV as a beneficial marker for preoperative risk stratification.

• Using a prospectively maintained database of patients receiving minimally invasive radical prostatectomy at a UK center between 2007 and 2019, a total of 251 patients with NCCN high or very high-risk prostate cancer were selected and followed (median follow up was 4.50 years).

• In multivariable analysis, four factors (TV, pathological grade group, pathological T stage, positive margin >3 mm) were identified to be linked with biochemical recurrence (BCR) and time to treatment failure (TTF).

• TV, as a predictor of BCR and TTF at 5 years, generated an area under the curve (AUC) of 0.71 and 0.75, respectively.

• An increase in AUC to 0.84 and 0.85 for BCR and TFF was seen with the inclusion of all 4 variables in the model.

• A significance difference in time to BCR was shown by a 2.50 cm TV cut off, p < 0.001.