BACKGROUND: An increased @entity5 volume threshold (<2.5   ml) is suggested to define insignificant @entity263 (iPCa). We hypothesize that an increasing @entity5 volume within iPCa @entity1 increases the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS: We relied on RP @entity1 treated between 1992 and 2008. Multivariable Cox regression analyses predicting BCR within @entity1 harboring favorable pathological characteristics ( <=pT2, pN0/Nx, Gleason 3   +   3). Kaplan-Meier analysis was performed for BCR-free survival within iPCa @entity1 ( <=pT2, pN0/Nx, Gleason 3   +   3, @entity5 volume: <0.5 vs. 0.5-2.49   ml). RESULTS: From 1,829 @entity1 , 141 (7.7%) and 310 (16.9%) harbored iPCa ( @entity5 volume: <0.5 vs. 0.5-2.49   ml), respectively. Of those, 21 (14.9%) versus 31 (10.0%) had PSA >10   ng/ml. @entity5 volume achieved independent predictor status for BCR. Specifically, iPCa @entity1 with increasing @entity5 volume (0.5-2.49   ml) were at higher risk of BCR after RP than those with @entity5 volume <0.5   ml (HR: 8.8, 95% CI: 1.2-65.9, P   =   0.04). Kaplan-Meier analysis recorded superior BCR-free survival in iPCa @entity1 with lower @entity5 volume (<0.5   ml) (log-rank P   =   0.009). The 10-year cancer-specific death rate was 0 versus 0.5%. CONCLUSIONS: Contemporary iPCa definition incorporates intermediate and high-risk @entity1 (PSA: 10-20 and >20   ng/ml). Despite most favorable pathological characteristics, iPCa @entity1 are not devoid of BCR after RP. Moreover, iPCa @entity1 were at higher risk of BCR, when increasing @entity5 volume up to 2.49   ml was at play. Taken together the contemporary concept of iPCa is suboptimal. Especially, an increased @entity5 volume threshold for defining iPCa cannot be recommended according to our data. Clinicians might take these considerations into account during decision-making process.

@entity5 volume in insignificant XXXX : increasing threshold gains increasing risk.

@entity5 :: ('MESH:D009369', 'Disease') :: ['Tumor', 'tumor'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity263 :: ('MESH:D011471', 'Disease') :: ['prostate cancer']
@entity263 :: (MESH:D011471,Disease) :: ['prostate cancer']
