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"apellidos" => "Silmi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357861200056X?idApp=UINPBA00004N" "url" => "/21735786/0000003600000002/v1_201304251738/S217357861200056X/v1_201304251738/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Relation between prostate gland volume and some histological markers of malignancy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "86" "paginaFinal" => "90" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. González-Enguita, M.J. Fernández-Aceñero, J.V. García-Cardoso, L. López-Pérez, F. Manzarbeitia, R. Vela-Navarrete" "autores" => array:6 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "González-Enguita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M.J." "apellidos" => "Fernández-Aceñero" "email" => array:1 [ 0 => "mgg10167@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J.V." "apellidos" => "García-Cardoso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "López-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "F." 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"apellidos" => "Vela-Navarrete" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The total volume of the prostate gland (TVPG) determined by transabdominal ultrasound or, more precisely, by transrectal ultrasound (TRUS), or the weight of the gland after radical prostatectomy has been associated for years with different variables of malignancy,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but rarely incorporated to prognostic nomograms. Simultaneously, the TVPG has been considered an argument in diagnostic procedures (PSA level, PSA density), for instructions and number of biopsies (sextant, saturation), repeat biopsies, as well as markers of malignancy such as Gleason score, tumor volume, and multifocality.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Similarly, the total volume or weight of the prostate gland has been used to compare the Gleason score obtained with the biopsy to the corresponding one measured in the surgical piece, or to the incidence of recurrence after radical prostatectomies.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–10</span></a> Finally, the greater malignancy of the cancer process in low-volume prostates has been the argument used to question therapeutic strategies such as watchful waiting or focalized treatment projects. The aim of this study is to assess whether there is any relation between prostate volume and some histological criteria of malignancy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We reviewed the radical prostatectomy specimens of 100 consecutive patients who received no preoperative hormonal treatment, operated at the Urology Department of the Fundación Jiménez Díaz in Madrid. These surgical samples were processed in the Pathological Anatomy laboratory following a common protocol. The information on the Gleason score, tumor volume, multifocality, vascular or neural invasion, pT stage, and presence of PIN foci was retrospectively collected. We performed a statistical analysis with the Chi-square technique to assess the possible association between the size of the gland (estimated from the weight and classified into three groups: <40<span class="elsevierStyleHsp" style=""></span>g (33%), >40 and <90<span class="elsevierStyleHsp" style=""></span>g (61%) and >90<span class="elsevierStyleHsp" style=""></span>g (6%), and various variables suggestive of poor tumor prognosis (grade, multifocality, stage, vascular invasions, etc.). For this analysis, the statistical package SPSS 13.0 for Windows has been used, setting a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 value for significance.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">We found a statistically significant association (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) between the weight of the gland and the tumor volume, as 15 out of 33 glands weighing less than 40<span class="elsevierStyleHsp" style=""></span>g showed tumor involvement of more than 50% of the gland, which contrasts with 0 out of 6 patients with total weight exceeding 90<span class="elsevierStyleHsp" style=""></span>g. We also found a significant association between multifocality and weight (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), since 24 out of 33 glands under 40<span class="elsevierStyleHsp" style=""></span>g had bilateral multifocality compared with just 1 out of 6 glands weighing more than 90<span class="elsevierStyleHsp" style=""></span>g. Neural invasion and a greater number of PIN foci were more frequent in small prostates, but the difference did not reach statistical significance. The combined Gleason grade was higher in small glands.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the small sample size, which limits the statistical power, our results seem to confirm previous observations and remind us of the convenience of using the TVPG as a reference for the indication of diagnostic procedures, especially prostate biopsy, and support of therapeutic strategies.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The prostate volume and indication for biopsy driven by the increase of the PSA (T<span class="elsevierStyleInf">1</span>C): the close relation between the PSA level and volume of the prostate gland has been recognized for years. The PSA value along with the digital examination of the prostate gland, which itself provides rough volumetric information, are the first scans performed in the evaluation of patients with potential risk of prostate cancer. Initially, the cut or PSA level of 4.0<span class="elsevierStyleHsp" style=""></span>ng/ml was considered as a primary reference to raise suspicion of prostate cancer and justify the performance of a prostate biopsy. Although there is still no minimum PSA cut-off point,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> all comments that follow started from the 4.0<span class="elsevierStyleHsp" style=""></span>ng/ml reference. However, it soon was recognized that the total volume of the prostate gland, more precisely measured with the progress of transabdominal and transrectal ultrasound, significantly affected the PSA level,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,12,13</span></a> and the PSA density concept was applied as a reference to advise or delay the prostate biopsy.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The PSA index<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> was proposed for the same purpose. However, the profitability of this new standard has not been considered of sufficient value, therefore, decreasing interest in it. To enhance the certainty of the PSA density, it was proposed to refer it to the volume of the adenoma or transition zone (TZ)<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> with promising results that have not arisen more enthusiasm, although the specificity of the PSA significantly improves in high-volume prostates.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Another alternative to increase the specificity of PSA in patients with total PSA equal to or greater than 4.0<span class="elsevierStyleHsp" style=""></span>ng/ml was to determine the free PSA (FPSA)<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> and use this figure as a reference, directly or by using the FPSA index. This approach has certainly had greater disclosure and is a common benchmark in clinical practice, considering that when it is greater than 25% it is oriented in the sense of adenoma (BPH), and when it is below 15% toward prostate cancer.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In a recent work, the potential usefulness of PSA density is raised depending on the volume of the transition zone to determine the biopsy in patients with PSA values between 2 and 4<span class="elsevierStyleHsp" style=""></span>ng/ml, suggesting that it reduces the performance of unnecessary biopsies.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Prostate volume and number of biopsies: assuming similar PSA levels, prostate biopsy yield is reduced in parallel with the volume of the prostate gland. To get a greater profitability of the biopsy in high-volume prostates, we have followed divergent options. On the one hand, we tried to improve the PSA specificity by proposing assessments and indexes, such as those mentioned above (FPSA, FPSA index). On the other hand, we decided simply to increase the number of prostate biopsies which, in general, followed the proposal that the greater the volume, the greater the number of biopsies, categorizing even the number of biopsies that should be performed vs. a specific prostate volume. Thus, we have moved from the traditional sextant biopsy to saturation biopsy, with 21 doses. The number of 11 doses was the most common recommendation for prostate volumes greater than 50<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In order to try to explain the low yield of the prostate biopsy in patients with PSA greater than 4.0<span class="elsevierStyleHsp" style=""></span>ng/ml, volumetric reasons have commonly been proposed; in fact, the sextant biopsy obtains a 9<span class="elsevierStyleHsp" style=""></span>cm (6 times 1.5<span class="elsevierStyleHsp" style=""></span>cm) sample, representing approximately 10% of a 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> prostate gland, and only 1% of a 70<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> gland. Again, in this case, most multifocality of prostate cancer or high-grade PIN in small volume glands with cancer and the low topography of cancer in high-volume glands have been ignored in the argument.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Prostate volume and Gleason score in biopsies and surgical specimens: the small-volume prostate glands harbor more aggressive cancers and are those that show higher pathologic grades.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,21–24</span></a> The existing relation between the volume of the gland and the degree of malignancy expressed by the Gleason score has been the subject of numerous studies. When we analyzed the anatomic distribution and degree of malignancy of prostate tumors of small volume, described as indolent, it was observed that this finding, the genuine small-volume tumor not associated with other features of greater aggressiveness is given precisely in larger prostates.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It is also small volume glands which most frequently show a higher Gleason score in radical prostatectomy pieces compared with the data obtained in the previous biopsy. Turley et al. compared the outcome of the prostate biopsy and radical prostatectomy in 586 patients whose prostate volume was determined by TRUS.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The prostate volume was categorized into different groups: 20<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> or less, between 20 and 40, between 40 and 60, and more than 60. The Gleason sum was also categorized into three subgroups: between 2 and 6, 3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>4, and 4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3, or higher. They found that in 24% of the cases, the piece showed a Gleason score greater than the biopsy, and that most of these cases corresponded to small volume prostates.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Prostate volume and therapeutic alternatives: assuming similar degrees of malignancy, in treatment decisions based only on the outcome of the prostate biopsy (T<span class="elsevierStyleInf">1</span>c), the prostate volume is another reference to consider. With regard to an extremely interesting topic at the moment, focused treatment of prostate cancer, it seems certain that it is the glands of small volume in which most often is the involvement of both lobes and there is increased tumor spread. This tumor mapping has also shown that it is precisely very large glands where focal, localized tumors can be found the best candidates for these procedures. These findings can also explain the excellent results obtained with prostate TUR in patients with large prostates and the incidental finding of some tumor focus (A1, in the old terminology).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The prostate volume is also a factor to consider when watchful waiting is chosen in patients who meet the recommended criteria.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27–29</span></a> It has been proposed in these circumstances, so as to be safe and eliminate evolutionary risks, to perform saturation biopsies, and even using the brachytherapy template before making therapeutic decisions. The discussed findings clearly guide in the sense that, in small volume prostates, there should be a more cautious indication of the watchful expectation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0070" class="elsevierStylePara elsevierViewall">The comparison of the weight of the prostate gland of 100 consecutive samples of radical prostatectomy with histological markers of malignancy has confirmed a close relation between them, so small prostates, especially smaller than or equal to 20<span class="elsevierStyleHsp" style=""></span>g, harbor tumors of great malignancy, while those of large volume, greater than 90<span class="elsevierStyleHsp" style=""></span>g, more often harbor unifocal and low grade tumors. We discuss the value of TVPG for diagnostic decisions (biopsies and repeat biopsies) and therapeutic strategies.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres100579" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec87743" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres100578" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec87744" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-08-23" "fechaAceptado" => "2011-10-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec87743" "palabras" => array:3 [ 0 => "Prostate carcinoma" 1 => "Volume" 2 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec87744" "palabras" => array:3 [ 0 => "Carcinoma de próstata" 1 => "Volumen" 2 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The relation between the total volume of the prostate gland or its weight after radical prostatectomy and the histological markers of malignancy in cases of prostate cancer is a controversial subject. We have analyzed 100 consecutive radical prostatectomy specimens in order to determine the relation between volume or weight of the prostate gland and the biological aggressiveness of the tumor process by different histological markers.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">One hundred consecutive radical prostatectomy specimens in patients who had not received pre-operative hormone treatment were retrospectively reviewed. These surgical samples were processed according to a standardized protocol. In a subsequent evaluation, the following were studied with greater detail: Gleason grade, tumor volume, multimodality, neural or vascular invasion, put stage, and presence of PIN foci. The histological findings were compared with the prostate gland weight using Windows SPAS, 13.0 statistical package with a significance value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. According to the prostate gland weight, three groups were established: <40<span class="elsevierStyleHsp" style=""></span>g (33%), 40–90<span class="elsevierStyleHsp" style=""></span>g (61%), and >90<span class="elsevierStyleHsp" style=""></span>g (6%).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A statistically significant association (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) was found between the prostate gland weight and tumor volume since 15 of the 33 glands with weight under 40<span class="elsevierStyleHsp" style=""></span>g accounted for more than 50% of the glands affected by tumor compared to none of the 6 patients with total weight over 90<span class="elsevierStyleHsp" style=""></span>g. A significant relation was also found between the multimodality and weight (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), so that 24 of the 33 glands under 40<span class="elsevierStyleHsp" style=""></span>g had bilateral multimodality compared to only 1 out of the 6 glands over 90<span class="elsevierStyleHsp" style=""></span>g. The neural invasion, number of PIN foci and the highest combined Gleason grade were frequent in low volume prostates, but the difference did not reach statistical significance.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our study indicates that large volume prostate glands have tumors with lower malignancy (tumor volume, bilateralism). This finding justifies the adequacy of using total volume of the prostate gland for diagnostic decision (indication of prostatic biopsy and their repetition) and the prognostic determination.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La relación entre el volumen total de la glándula prostática, o el peso de la misma tras prostatectomía radical, y los marcadores histológicos de malignidad en casos de cáncer de próstata, es motivo de controversia. Hemos analizado 100 muestras consecutivas de prostatectomía radical para determinar la relación entre el volumen o el peso de la glándula prostática y la agresividad biológica del proceso tumoral expresado por diferentes marcadores histológicos.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se han revisado las piezas de prostatectomía radical de 100 pacientes consecutivos, que no recibieron tratamiento hormonal preoperatorio. Estas muestras quirúrgicas fueron procesadas siguiendo un protocolo común. En la ulterior valoración se investigó con mayor precisión: el grado de Gleason, volumen tumoral, multifocalidad, invasión vascular o neural, estadio pT y presencia de focos de PIN. Los hallazgos fueron comparados con el peso de la glándula utilizando el paquete estadístico de WINDOWS SPSS 13.0 con valor estadístico significativo de p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05. Según el peso de la glándula se formaron tres grupos:<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>g (33%), entre 40-90<span class="elsevierStyleHsp" style=""></span>g (61%) y<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>g (6%).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontró una asociación estadísticamente significativa (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001) entre el peso de la glándula y el volumen del tumor, ya que 15 de 33 glándulas de peso inferior a 40<span class="elsevierStyleHsp" style=""></span>g mostraron más del 50% de la glándula afectada por tumor, comparado con ninguno de los 6 pacientes con peso total mayor de 90<span class="elsevierStyleHsp" style=""></span>g. También se encontró relación significativa entre la multifocalidad y el peso (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,03), de forma que 24 de 33 glándulas menores de 40<span class="elsevierStyleHsp" style=""></span>g tenían multifocalidad bilateral en comparación con solo una de 6 glándulas mayores de 90<span class="elsevierStyleHsp" style=""></span>g. La invasión neural, el número de focos de PIN y un grado combinado de Gleason más alto fueron más frecuentes en las próstatas peque¿nas, pero la diferencia no alcanzó significación estadística.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio indica que las glándulas prostáticas de gran volumen albergan tumores de menor malignidad (volumen tumoral, bilateralidad). El hallazgo justifica la conveniencia de contar con el volumen total de la glándula prostática para decisiones diagnósticas (indicación de biopsia prostática y repetición de las mismas) y determinación pronóstica.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: González-Enguita C, et al. Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad. 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