Cancers (Jun 2024)

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

  • Antonio Benito Porcaro,
  • Alberto Bianchi,
  • Sebastian Gallina,
  • Andrea Panunzio,
  • Alessandro Tafuri,
  • Emanuele Serafin,
  • Rossella Orlando,
  • Giovanni Mazzucato,
  • Paola Irene Ornaghi,
  • Francesco Cianflone,
  • Francesca Montanaro,
  • Francesco Artoni,
  • Alberto Baielli,
  • Francesco Ditonno,
  • Filippo Migliorini,
  • Matteo Brunelli,
  • Salvatore Siracusano,
  • Maria Angela Cerruto,
  • Alessandro Antonelli

DOI
https://doi.org/10.3390/cancers16112137
Journal volume & issue
Vol. 16, no. 11
p. 2137

Abstract

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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.

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