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Tumor upgrading among very favorable intermediate-risk prostate cancer patients treated with robot-assisted radical prostatectomy: how can it impact the clinical course?

  • Urology - Original Paper
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Abstract

Purpose

We sought to investigate predictors of unfavorable tumor upgrading in very favorable intermediate-risk (IR) prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy, in addition to evaluate how it may affect the risk of disease progression.

Methods

A very favorable subset of IR PCa patients presenting with prostate-specific antigen (PSA) < 10 ng/mL, percentage of biopsy positive cores (BPC) < 50%, and either International Society of Urological Pathology (ISUP) grade group 1 and clinical stage T2b or ISUP grade group 2 and clinical stage T1c-2b was identified. Unfavorable pathology at radical prostatectomy was defined as the presence of ISUP grade group > 2 (unfavorable tumor upgrading), extracapsular extension (ECE), and seminal vesicle invasion (SVI). Disease progression was defined as the event of biochemical recurrence and/or local recurrence and/or distant metastases. Associations were evaluated by Cox regression and logistic regression analyses.

Results

Overall, 210 patients were identified between January 2013 and October 2020. Unfavorable tumor upgrading was detected in 71 (33.8%) cases, and adverse tumor stage, including ECE or SVI in 18 (8.6%) and 11 (5.2%) patients, respectively. Median (interquartile range) follow-up was 38.5 (16–61) months. PCa progression occurred in 24 (11.4%) patients. Very favorable IR PCa patients with unfavorable tumor upgrading at final pathology showed a persistent risk of disease progression, which hold significance after adjustment for all factors (Hazard Ratio [HR]: 5.95, 95% Confidence Interval [CI]: 1.97–17.92, p = 0.002) of which PSA was an independent predictor (HR: 1.52, 95% CI 1.12–2.08, p = 0.008). Moreover, these subjects were more likely to belong to the biopsy ISUP grade group 2.

Conclusions

Very favorable IR PCa patients hiding unfavorable tumor upgrading were more likely to experience disease progression. Unfavorable tumor upgrading involved about one-third of cases and was less likely to occur in patients presenting with biopsy ISUP grade group 1. Tumor misclassification is an issue to discuss, when counseling this subset of patients for active surveillance because of the risk of delayed active treatment.

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Data availability

All data generated or analyzed during this study are included in this article. Further enquires can be directed to the corresponding author.

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Funding

The authors declare they have not receive any financial support.

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Authors and Affiliations

  1. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy

    Antonio Benito Porcaro, Alberto Bianchi, Sebastian Gallina, Emanuele Serafin, Nicolò Trabacchin, Rossella Orlando, Paola Irene Ornaghi, Giovanni Mazzucato, Stefano Vidiri, Damiano D’Aietti, Francesca Montanaro, Davide Brusa, Giulia Marafioti Patuzzo, Francesco Artoni, Alberto Baielli, Filippo Migliorini, Vincenzo De Marco, Alessandro Veccia, Maria Angela Cerruto & Alessandro Antonelli

  2. Department of Urology, Vito Fazzi Hospital, Lecce, Italy

    Andrea Panunzio & Alessandro Tafuri

  3. Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Matteo Brunelli

  4. Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    Salvatore Siracusano

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  1. Antonio Benito Porcaro
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Contributions

A.B. PORCARO: project development, data analysis and interpretation, manuscript writing. A. Bianchi and A. Panunzio: data collection, manuscript writing. A. Bianchi, A. Panunzio, S. Gallina, E. Serafin, N. Trabacchin, R. Orlando, P.I. Ornaghi, G. Mazzucato, S. Vidiri, D. D’Aietti, F. Montanaro, D. Brusa, G. Marafioti Patuzzo, F. Artoni, and A. Baielli: data collection. A. Tafuri, F. Migliorini, V. De Marco, A. Veccia, M. Brunelli, S. Siracusano, M.A. Cerruto, and A. Antonelli: supervision and critical revision for important intellectual content.

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Correspondence to Antonio Benito Porcaro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by our Institutional Review Board. Data were collected prospectively but evaluated retrospectively as such Ethical Committee Approval was not required.

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Porcaro, A.B., Bianchi, A., Panunzio, A. et al. Tumor upgrading among very favorable intermediate-risk prostate cancer patients treated with robot-assisted radical prostatectomy: how can it impact the clinical course?. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04019-3

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