UPJ INSIGHT Impact of Zone of Origin in Anterior Dominant Prostate Cancer: Long-Term Biochemical Recurrence-Free Survival in an Anatomically Well-Characterized Cohort

By: Samson W. Fine, MD; Hikmat A. Al-Ahmadie, MD; Emily Vertosick, MPH; Andrew J. Vickers, PhD; Ying-Bei Chen, MD, PhD; Anuradha Gopalan, MD; Judy Sarungbam, MD; S. Joseph Sirintrapun, MD; Satish K. Tickoo, MD; James A. Eastham, MD; Peter T. Scardino, MD; Victor E. Reuter, MD | Posted on: 01 Sep 2022

Fine SW, Al-Ahmadie HA, Vertosick E, et al. Impact of zone of origin in anterior dominant prostate cancer: long-term biochemical recurrence-free survival in an anatomically well-characterized cohort. Urol Pract. 2022; 10.1097/UPJ.0000000000000322.

Study Need and Importance

Many have examined the role of zonal origin in predicting prostate cancer (PCa) outcomes, comparing tumors of transition zone (TZ) and peripheral zone (PZ) origin, generally finding that TZ tumors are associated with lower pathological grade/stage and biochemical recurrence (BCR) than PZ tumors. Although the anterior prostate contains both TZ and PZ (anterolateral “horns”) tissue, few studies have focused on anterior PCa of differing zones. We studied anterior dominant PCa, annotated by zone of origin and radical prostatectomy pathology outcomes, and for the first time examined BCR outcomes in an anterior dominant PCa cohort divided by zonal origin.

Figure. Kaplan-Meier estimates of BCR-free survival by tumor location. Blue line indicates anterior PZ tumors; red line indicates anterior TZ tumors.

What We Found

From 197 anterior dominant PCas, 97 (49%) anterior PZ and 70 (36%) TZ tumors were similar for Gleason score/Grade group, pathological stage and margin positivity; 10 patients with anterior PZ and 5 with TZ PCa experienced BCR. Median followup among survivors was 9.5 years. At 5 and 10 years, BCR-free survival was 91% and 89% in anterior PZ and 94% and 92% in TZ tumors, respectively, with no evidence of difference in time to BCR on univariate analysis (see Figure). We postulate that anterior PCa of both zones is associated with lower BCR than that reported for posterior PCa due to anatomical distinctions, including differences in nerve distribution/extraprostatic extension and absent seminal vesical invasion.


Main limitations are cohort size and the era (early 2000s) from which it was drawn, with 1/3 of cases having Grade group 1 at radical prostatectomy and few cases of Grade group 4/5.

Interpretations for Patient Care

Long-term BCR-free survival was not significantly associated with zone of origin in an anatomically well-characterized cohort of anterior dominant PCa. If corroborated in contemporary studies differentiating anterior from posterior PZ tumors, the findings may be useful in counseling for patients with anterior dominant PCa.