1. Prognostic Impact and Clinical Implications of Adverse Tumor Grade in Very Favorable Low- and Intermediate-Risk Prostate Cancer Patients Treated with Robot-Assisted Radical Prostatectomy: Experience of a Single Tertiary Referral Center.
- Author
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Porcaro, Antonio Benito, Bianchi, Alberto, Gallina, Sebastian, Panunzio, Andrea, Tafuri, Alessandro, Serafin, Emanuele, Orlando, Rossella, Mazzucato, Giovanni, Ornaghi, Paola Irene, Cianflone, Francesco, Montanaro, Francesca, Artoni, Francesco, Baielli, Alberto, Ditonno, Francesco, Migliorini, Filippo, Brunelli, Matteo, Siracusano, Salvatore, Cerruto, Maria Angela, and Antonelli, Alessandro
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SURGICAL robots , *RISK assessment , *STATISTICAL models , *BIOPSY , *CANCER relapse , *PROSTATE-specific antigen , *BODY mass index , *STATISTICAL hypothesis testing , *CANCER invasiveness , *RADICAL prostatectomy , *LOGISTIC regression analysis , *SALVAGE therapy , *PROSTATE tumors , *TUMOR grading , *TERTIARY care , *CANCER patients , *DESCRIPTIVE statistics , *MULTIVARIATE analysis , *AGE distribution , *RETROSPECTIVE studies , *METASTASIS , *LONGITUDINAL method , *ODDS ratio , *SURGICAL margin , *STATISTICS , *DATA analysis software , *CONFIDENCE intervals , *TUMOR classification , *TRANSURETHRAL prostatectomy , *SURVIVAL analysis (Biometry) , *DISEASE progression , *PROPORTIONAL hazards models , *DISEASE risk factors - Abstract
Simple Summary: The prognosis of PCa at diagnosis is assessed by classification systems that aim to group homogenous sets of patients. However, great heterogeneity exists within these risk groups, in terms of prognostic factors and treatment options. The aim of this study was to assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer patients treated with robot-assisted radical prostatectomy at a high-volume tertiary referral center. Objectives: To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained institutional database. Adverse tumor grade was defined as pathology ISUP grade group > 2. Disease progression was defined as a biochemical recurrence event and/or local recurrence and/or distant metastases. Associations were assessed by Cox's proportional hazards and logistic regression model. Results: Between January 2013 and October 2020, the study evaluated a population of 289 patients, including 178 low-risk cases (61.1%) and 111 intermediate-risk subjects (38.4%); unfavorable tumor grade was detected in 82 cases (28.4%). PCa progression, which occurred in 29 patients (10%), was independently predicted by adverse tumor grade and biopsy ISUP grade group 2, with the former showing stronger associations (hazard ratio, HR = 4.478; 95% CI: 1.840–10.895; p = 0.001) than the latter (HR = 2.336; 95% CI: 1.057–5.164; p = 0.036). Older age and biopsy ISUP grade group 2 were independent clinical predictors of adverse tumor grade, associated with larger tumors that eventually presented non-organ-confined disease. Conclusions: In a very favorable PCa patient population, adverse tumor grade was an unfavorable prognostic factor for disease progression. Active surveillance in very favorable intermediate-risk patients is still a hazard, so molecular and genetic testing of biopsy specimens is needed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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