A contemporary analysis of disease upstaging of Gleason 3 + 3 prostate cancer patients after robot‐assisted laparoscopic prostatectomy

Abstract

Abstract Background Risk of biochemical recurrence (BCR) in localised prostate cancer can be stratified using the 5‐tier Cambridge Prognostic Group (CPG) or 3‐tier European Association of Urology (EAU) model. Active surveillance is the current recommendation if CPG1 or EAU low‐risk criteria are met. We aimed to determine the contemporary rates of upgrading, upstaging and BCR after radical prostatectomy for CPG1 or EAU low‐risk disease. Methods A database of all robotic‐assisted laparoscopic prostatectomies (RALPs) performed in Glasgow between 12/2015 and 05/2022 was analysed. Rates of upgrading, upstaging and BCR post‐RALP for CPG1 or EAU low‐risk disease were defined. Univariate and multivariate analysis were performed to assess the relationship between patient factors and outcomes. Results A total of 1223 RALP cases were identified. A total of 12.6% met CPG1 criteria with 70.1% and 25.3% upgraded and upstaged to extraprostatic disease post‐operatively respectively. A total of 5.8% met EAU low‐risk criteria with 60.6% upgraded and 25.4% upstaged to extraprostatic disease post‐operatively respectively. CPG1 (p < 0.0001) and EAU low‐risk (p = 0.02) patients were at a significantly higher risk of BCR if upstaged. Discussion Many patients who met CPG1 or EAU low‐risk criteria were upgraded post‐RALP and approximately 25% were upstaged due to extraprostatic disease. Upstaging puts patients at a significantly higher risk of BCR.

Keywords

• active surveillance
• Gleason 3+3
• prostate cancer
• robotic surgery