Prognostic impact of palpable prostate tumors on disease progression after robot-assisted radical prostatectomy: a single center experience

Author:

Porcaro Antonio Benito1,Gallina Sebastian2,Bianchi Alberto2,Tafuri Alessandro3,Serafin Emanuele2,Panunzio Andrea3,Mazzucato Giovanni2,Orlando Rossella2,Ditonno Francesco2,Ornaghi Paola Irene2,Rizzetto Riccardo1,Cerrato Clara2,de Marco Vincenzo1,Brunelli Matteo2,Siracusano Salvatore4,Cerruto Maria Angela2,Antonelli Alessandro2

Affiliation:

1. Azienda Ospedaliera Universitaria Integrata Verona

2. University of Verona, Azienda Ospedaliera Universitaria Integrata

3. Vito Fazzi Hospital

4. University of L’Aquila

Abstract

Abstract Objective: This study aimed to evaluate the impact of palpable prostate tumors on digital rectal exam (DRE) on the disease progression of prostate cancer (PCa) treated with RARP surgery in a tertiary referral center. Materials and methods: Overall 901 patients were evaluated in a period ranging from January 2013 to October 2020. In the surgical specimen, unfavorable pathology included ISUP grade group ≥3, seminal vesicle invasion (SVI), and pelvic lymph node invasion (PLNI). Disease progression was defined as the occurrence of biochemical recurrence and/or local recurrence and/or distant metastases; its association with the primary endpoint was evaluated by Cox’s proportional model. Results: Palpable prostate tumors were detected in 359 (39.8%) patients. The overall median (IQR) follow-up was 40 months (17-59). PCa progressed in 159 cases (17.6%). Nodularity or induration of the prostate at DRE was significantly associated with features of unfavorable pathology, increased risk of PCa progression (hazard ratio, HR=1.902; 95% CI:1.389–2.605; p<0.0001) and, on multivariable analysis, was an independent prognostic factor for disease progression after adjusting for clinical and pathological variables. Conclusions: Prostate tumors presenting with an abnormal DRE finding have an independent adverse outcome for disease progression after PCa surgery. They provide also independent prognostic information, as they may be more aggressive than impalpable PCa.

Publisher

Research Square Platform LLC

Reference11 articles.

1. Mottet N, Cornford P, van den Bergh RCN, et al (2022) EAU - EANM - ESTRO - ESUR - ISUP - SIOG Guidelines on Prostate Cancer. In: European Association of Urology. https://uroweb.org/guidelines/prostate-cancer. Accessed 15 Nov 2022

2. Schaeffer E, Srinivas S, An Y, et al (2022) Prostate Cancer, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. In: National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 15 Nov 2022

3. Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review;Broeck T;Eur Urol,2019

4. The Role of Anesthesia in Surgical Mortality;Dripps RD;JAMA,1961

5. The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy;Sebben M;World J Urol,2020

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