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. 2024 Feb 11:16:17562872241229260.
doi: 10.1177/17562872241229260. eCollection 2024 Jan-Dec.

The impact of prognostic group classification on prostate cancer progression in intermediate-risk patients according to the European Association of Urology system: results in 479 patients treated with robot-assisted radical prostatectomy at a single tertiary referral center

Antonio Benito Porcaro  1 , Alberto Bianchi  2 , Andrea Panunzio  3 , Sebastian Gallina  2 , Alessandro Tafuri  3 , Emanuele Serafin  2 , Rossella Orlando  2 , Giovanni Mazzucato  2 , Stefano Vidiri  2 , Damiano D'Aietti  2 , Francesca Montanaro  2 , Giulia Marafioti Patuzzo  2 , Francesco Artoni  2 , Alberto Baielli  2 , Francesco Ditonno  2 , Riccardo Rizzetto  2 , Alessandro Veccia  2 , Alessandra Gozzo  2 , Vincenzo De Marco  2 , Matteo Brunelli  4 , Maria Angela Cerruto  2 , Alessandro Antonelli  2
Affiliations

The impact of prognostic group classification on prostate cancer progression in intermediate-risk patients according to the European Association of Urology system: results in 479 patients treated with robot-assisted radical prostatectomy at a single tertiary referral center

Antonio Benito Porcaro et al. Ther Adv Urol. .

Abstract

Background: Treatment outcomes in intermediate-risk prostate cancer (PCa) may be impaired by adverse pathology misclassification including tumor upgrading and upstaging. Clinical predictors of disease progression need to be improved in this category of patients.

Objectives: To identify PCa prognostic factors to define prognostic groups in intermediate-risk patients treated with robot-assisted radical prostatectomy (RARP).

Design: Data from 1143 patients undergoing RARP from January 2013 to October 2020 were collected: 901 subjects had available follow-up, of whom 479 were at intermediate risk.

Methods: PCa progression was defined as biochemical recurrence and/or local recurrence and/or distant metastases. Study endpoints were evaluated by statistical methods including Cox's proportional hazards, Kaplan-Meyer survival curves, and binomial and multinomial logistic regression models.

Results: After a median (interquartile range) of 35 months (15-57 months), 84 patients (17.5%) had disease progression, which was independently predicted by the percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 for clinical factors and by ISUP > 2, positive surgical margins and pelvic lymph node invasion for pathological features. Patients were classified into clinical and pathological groups as favorable, unfavorable (one prognostic factor), and adverse (more than one prognostic factor). The risk of PCa progression increased with worsening prognosis through groups. A significant positive association was found between the two groups; consequently, as clinical prognosis worsened, the risk of detecting unfavorable and adverse pathological prognostic clusters increased in both unadjusted and adjusted models.

Conclusion: The study identified factors predicting disease progression that allowed the computation of highly correlated prognostic groups. As the prognosis worsened, the risk of PCa progression increased. Intermediate-risk PCa needs more prognostic stratification for appropriate management.

Keywords: adverse pathology; intermediate-risk prostate cancer; prognostic factors; prognostic groups; prostate cancer; prostate cancer progression; robot-assisted radical prostatectomy; tumor upgrading; tumor upstaging.

Plain language summary

A study on 479 patients looked at how prognostic group classification affects progression in patients with intermediate-risk prostate cancer treated with robot-assisted radical prostatectomy Prostate cancer is a serious health concern in men, and those with intermediate-risk prostate cancer may experience disease progression. Urologists use various methods to predict the risk of progression in these patients. However, sometimes the predictions are not accurate. Therefore, researchers conducted a study to identify factors that could help predict disease progression in patients with intermediate-risk prostate cancer who underwent robot-assisted surgery. This study on 479 patients found that a percentage of biopsy-positive cores ⩾ 50% and the International Society of Urological Pathology (ISUP) grade group 3 were predictive factors of disease progression. Additionally, factors like ISUP > 2, positive surgical margins, and pelvic lymph node invasion also predicted disease progression. Patients were classified into three groups based on their clinical and pathological features: favorable, unfavorable (one negative prognostic factor), and adverse (more than one negative prognostic factor). The risk of prostate cancer progression increased as the prognosis worsened through these groups. The study concluded that a more accurate stratification of intermediate-risk prostate cancer patients is needed to manage the disease effectively.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Kaplan–Meyer survival curves of PCa progression stratified by clinical prognostic groups in 479 intermediate-risk patients classified according to the EAU system. The median survival time of PCa progression was longer for the favorable prognostic group (94 months; 95% CI: 92.4–95.5 months) when compared with the unfavorable/adverse prognostic one (81 months; 95% CI: 69.9–92.3) and the difference was significant (Mantel-Cox log-rank test: p = 0.001). See also materials, methods, and results. EAU, European Association of Urology; PCa, prostate cancer.
Figure 2.
Figure 2.
Univariate analysis of Kaplan–Meyer survival curves of PCa progression by clinical prognostic groups in 479 intermediate-risk cases classified according to the EAU system. The median survival time of PCa progression was longer for the favorable prognostic group (94 months; 95% CI: 92.4–95.5 months) when compared with the unfavorable group (83.4 months; 95% CI: 75.3–90.6 months) and with the adverse group (56 months; 95% CI: 43.0–68.9 months), and the difference was significant (Mantel-Cox log-rank test: p < 0.001). See also materials, methods, and results. EAU, European Association of Urology; PCa, prostate cancer.
Figure 3.
Figure 3.
Univariate analysis of Kaplan–Meyer survival curves of PCa progression stratified by pathological prognostic groups in 479 intermediate-risk patients classified according to the EAU system. The median survival time of PCa progression was longer for the favorable prognostic group (94 months; 95% CI: 92.6–95.3 months) when compared with the unfavorable/adverse prognostic one (81 months; 95% CI: 69.9–92.3) and the difference was significant (Mantel-Cox log-rank test: p = 0.001). See also materials, methods, and results. EAU, European Association of Urology; PCa, prostate cancer.
Figure 4.
Figure 4.
Univariate analysis of Kaplan–Meyer survival curves of PCa progression by clinical prognostic groups in 479 intermediate-risk cases classified according to the EAU system. The median survival time of PCa progression was longer for the favorable prognostic group (94 months; 95% CI: 92.6–95.3 months) when compared with the unfavorable group (83 months; 95% CI: 73.9–92.0 months) and with the adverse group (60 months; 95% CI: 51.3–68.6 months), with the difference being significant (Mantel-Cox log-rank test: p < 0.001). See also materials, methods, and results. EAU, European Association of Urology; PCa, prostate cancer.
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References

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