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
by
, , ,
Antonio Benito Porcaro
1
,
Alberto Bianchi
1,
Sebastian Gallina
1,
Andrea Panunzio
1,
Alessandro Tafuri
2,
Emanuele Serafin
1,
Rossella Orlando
1,
Giovanni Mazzucato
1,
Paola Irene Ornaghi
1,
Francesco Cianflone
1,
Francesca Montanaro
1,
Francesco Artoni
1,
Alberto Baielli
1,
Francesco Ditonno
1,3,*,
Filippo Migliorini
1,
Matteo Brunelli
4, 
Salvatore Siracusano
5, 
Maria Angela Cerruto
1 and
Alessandro Antonelli
1 1
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy
2
Department of Urology, Vito Fazzi Hospital, 73110 Lecce, Italy
3
Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
4
Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy
5
Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(11), 2137; https://doi.org/10.3390/cancers16112137
Submission received: 6 May 2024
/
Revised: 25 May 2024
/
Accepted: 30 May 2024
/
Published: 4 June 2024
(This article belongs to the Special Issue Robot-Assisted Radical Prostatectomy for Urologic Cancer: State of the Art)
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.
Abstract
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.
