International Brazilian Journal of Urology (Aug 2024)

The 2012 Briganti nomogram not only predicts lymph node involvement but also disease progression in surgically treated intermediate-risk prostate cancer patients with PSA <10 ng/mL, ISUP grade group 3, and clinical stage up to cT2b

  • Antonio Benito Porcaro,
  • Andrea Panunzio,
  • Rossella Orlando,
  • Francesca Montanaro,
  • Alberto Baielli,
  • Francesco Artoni,
  • Sebastian Gallina,
  • Alberto Bianchi,
  • Giovanni Mazzucato,
  • Emanuele Serafin,
  • Giulia Marafioti Patuzzo,
  • Alessandro Veccia,
  • Riccardo Rizzetto,
  • Matteo Brunelli,
  • Filippo Migliorini,
  • Riccardo Bertolo,
  • Alessandro Tafuri,
  • Maria Angela Cerruto,
  • Alessandro Antonelli

DOI
https://doi.org/10.1590/s1677-5538.ibju.2024.0003
Journal volume & issue
Vol. 50, no. 4
pp. 450 – 458

Abstract

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ABSTRACT Purpose We assessed the prognostic impact of the 2012 Briganti nomogram on prostate cancer (PCa) progression in intermediate-risk (IR) patients presenting with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b treated with robot assisted radical prostatectomy eventually associated with extended pelvic lymph node dissection. Materials and Methods From January 2013 to December 2021, data of surgically treated IR PCa patients were retrospectively evaluated. Only patients presenting with the above-mentioned features were considered. The 2012 Briganti nomogram was assessed either as a continuous and a categorical variable (up to the median, which was detected as 6%, vs. above the median). The association with PCa progression, defined as biochemical recurrence, and/or metastatic progression, was evaluated by Cox proportional hazard regression models. Results Overall, 147 patients were included. Compared to subjects with a nomogram score up to 6%, those presenting with a score above 6% were more likely to be younger, had larger/palpable tumors, presented with higher PSA, underwent tumor upgrading, harbored non-organ confined disease, and had positive surgical margins at final pathology. PCa progression, which occurred in 32 (21.7%) cases, was independently predicted by the 2012 Briganti nomogram both considered as a continuous (Hazard Ratio [HR]:1.04, 95% Confidence Interval [CI]:1.01-1.08;p=0.021), and a categorical variable (HR:2.32; 95%CI:1.11-4.87;p=0.026), even after adjustment for tumor upgrading. Conclusions In IR PCa patients with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b, the 2012 Briganti nomogram independently predicts PCa progression. In this challenging subset of patients, this tool can identify prognostic subgroups, independently by upgrading issues.

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