Author:
Porcaro Antonio Benito,Bianchi Alberto,Gallina Sebastian,Panunzio Andrea,Serafin Emanuele,Mazzucato Giovanni,Orlando Rossella,Montanaro Francesca,Patuzzo Giulia Marafioti,Baielli Alberto,Artoni Francesco,Ditonno Francesco,Vidiri Stefano,D’Aietti Damiano,Migliorini Filippo,Rizzetto Riccardo,Veccia Alessandro,Gozzo Alessandra,Brunelli Matteo,Tafuri Alessandro,Cerruto Maria Angela,Antonelli Alessandro
Abstract
Abstract
Objectives
This study aimed to assess more clinical and pathological factors associated with prostate cancer (PCa) progression in high-risk PCa patients treated primarily with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) in a tertiary referral center.
Materials and methods
In a period ranging from January 2013 to October 2020, RARP and ePLND were performed on 180 high-risk patients at Azienda Ospedaliera Universitaria Integrata of Verona (Italy). PCa progression was defined as biochemical recurrence/persistence and/or local recurrence and/or distant metastases. Statistical methods evaluated study endpoints, including Cox’s proportional hazards, Kaplan-Meyer survival curves, and binomial logistic regression models.
Results
The median age of included patients was 66.5 [62–71] years. Disease progression occurred in 55 patients (30.6%), who were more likely to have advanced age, palpable tumors, and unfavorable pathologic features, including high tumor grade, stage, and pelvic lymph node invasion (PLNI). On multivariate analysis, PCa progression was predicted by advanced age (≥ 70 years) (HR = 2.183; 95% CI = 1.089–4377, p = 0.028), palpable tumors (HR = 3.113; 95% CI = 1.499–6.465), p = 0.002), and PLNI (HR = 2.945; 95% CI = 1.441–6.018, p = 0.003), which were associated with clinical standard factors defining high-risk PCa. Age had a negative prognostic impact on elderly patients, who were less likely to have palpable tumors but more likely to have high-grade tumors.
Conclusions
High-risk PCa progression was independently predicted by advanced age, palpable tumors, and PLNI, which is associated with standard clinical prognostic factors. Consequently, with increasing age, the prognosis is worse in elderly patients, who represent an unfavorable age group that needs extensive counseling for appropriate and personalized management decisions.
Funder
Università degli Studi di Verona
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology,Aging
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