Presentation Authors: Alberto Abrate*, Palermo, Italy, Daniele Romagnoli, Federico Mineo Bianchi, Bologna, Italy, Nicola Pavan, Trieste, Italy, Guglielmo Mantica, Andrea Romagnoli, Carlo Terrone, Genoa, Italy, Carlo Pavone, Vincenzo Serretta, Marco Vella, Palermo, Italy, Eugenio Brunocilla, Bologna, Italy, Andrea Gregori, Virginia Varca, Garbagnate Milanese, Milan, Italy, Alberto Diminutto, Salvatore Siracusano, Verona, Italy, Andrea Lissiani, Trieste, Italy, Angelo Porreca, Abano Terme, Padua, Italy, Riccardo Schiavina, Bologna, Italy, Alchiede Simonato, Palermo, Italy
Introduction: Localized low-risk prostate cancer (PCa) can have different biological behaviour and its treatment remains controversial. We investigated the incidence of unfavorable features (defined as ISUP Grade â‰¥ 3 and/or stage â‰¥ pT3a) after radical prostatectomy (RP), in patients initially diagnosed with microfocal PCa (miPCa) at prostate biopsy (PBx).
Methods: The current multicenter study included patients diagnosed with miPCa at PBx and having undergone RP. miPCa was defined as a single positive focus â‰¤ 3 mm. Patients were stratified according to the D&[prime]Amico risk classification and surgical approach (retropubic, laparoscopic, and robot assisted RP).
Results: Overall 647 patients were included: 461, 139 and 47 patients were classified as low-, intermediate- and high-risk according to the D&[prime]Amico risk classification, respectively. Mean age was 65.7 years. Mean PSA was 8.25 ng/ml and PSAD was 0.18. Overall 242 (37.4%) patients were upgraded after RP. Unfavorable characteristics were found in 172 (26.6%), 91 (52.9%) of which were previously classified as low-risk patients. 159 (34.5%) low-risk patients were upgraded after RP: an ISUP Grade ≥ 3 PCa was diagnosed in the 32.7% of them (42, 5 and 5 patients with ISUP Grade 3, 4 and 5 respectively). Moreover 113 (17.5%) patients had an extraprostatic extension of the cancer (pathological stage â‰¥ pT3a) and 119 (19.2%) had positive surgical margins. Overall 360 (55.6%), 203 (31.4%) and 84 (13.0%) patients had undergone retropubic, laparoscopic and robot assisted RP. Interestingly, no significant differences were reported in positive surgical margins incidence according to the surgical approach (p = 0.116), despite the different usage of the nerve sparing technique (35.6, 44.3 and 67.8% in retropubic, laparoscopic and robot assisted RP, respectively). It is also notable that 1 (0.2%) patient, previously diagnosed with a GS 6 PCa, was definitively classified as pT0 after RP. The ROC curve analysis demonstrated that PSA, PSAD, and D&[prime]Amico risk classification had an AUC value of 0.628, 0.681, and 0.631 respectively to predict the risk of unfavorable features. The PSAD had the best predictive ability, significantly higher than PSA (p = 0.01) but not than D&[prime]Amico risk classification (p = 0.05).
Conclusions: Patients with miPCa detection at PBx have a significant potential risk of ISUP Grade 3 and pT3 cancer at histological examination after RP. PSAD and the D&[prime]Amico risk classification could be helpful in the decision making process to indicate active surveillance or treatment.