Dr. Morgan et al attempt to associate disease aggressiveness with a ratio measurement combining dominant nodule and gland size (DNVR). Given contradictory findings within the literature regarding the importance of tumor volume (references 4, 8-18 in article), the novel measure DNVR described in this manuscript warrants further evaluation. Current predictive nomograms do not include tumor or gland size, although prior studies suggest that malignancies in smaller glands may be biologically more aggressive (references 24-27 in article). The authors posit that a higher dominant nodule-to-prostate volume ratio (DNVR) is associated with clinicopathologic outcomes and primary biochemical recurrence in their single institution cohort of >2000 patients. Understanding the Relationship Between Tumor Size, Gland Size, and Disease Aggressiveness in Men With Prostate CancerUrologyVol. 84Issue 2PreviewTo determine the relationship between prostate gland and tumor volume in men undergoing radical prostatectomy (RP) for prostate cancer. We hypothesized that larger tumors within smaller prostate glands are associated with more aggressive disease characteristics. Full-Text PDF ReplyUrologyVol. 84Issue 2PreviewWe appreciate this thoughtful editorial comment and agree that characteristics of our study sample, including our short follow-up and lower rate of biochemical recurrence, may have contributed to the lack of prognostic significance for dominant nodule-to-prostate volume ratio and tumor diameter. However, we also concede that dominant nodule-to-prostate volume ratio may not yield a clinically significant increase in accuracy when added to current predictive nomograms. We support further evaluation in higher-risk cohorts to better clarify these issues. Full-Text PDF