Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy.
Department of Urology, Vito Fazzi Hospital, Lecce, Italy.
J Robot Surg. 2023 Oct;17(5):2471-2477. doi: 10.1007/s11701-023-01669-w. Epub 2023 Jul 24.
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.
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.
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.
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.
本研究旨在评估在三级转诊中心，接受机器人辅助前列腺癌根治术（RARP）治疗的前列腺癌（PCa）患者中，可触及前列腺肿瘤对数字直肠检查（DRE）的影响。
共评估了 2013 年 1 月至 2020 年 10 月期间的 901 例患者。在手术标本中，不良病理包括国际泌尿病理学会分级≥3、精囊侵犯（SVI）和盆腔淋巴结侵犯（PLNI）。疾病进展定义为生化复发和/或局部复发和/或远处转移的发生；采用 Cox 比例模型评估其与主要终点的关系。
359 例（39.8%）患者可触及前列腺肿瘤。总的中位（IQR）随访时间为 40 个月（17-59）。159 例（17.6%）患者发生 PCa 进展。DRE 时前列腺结节或硬结与不良病理特征显著相关，增加了 PCa 进展的风险（危险比，HR=1.902；95%置信区间：1.389-2.605；p<0.0001），且在多变量分析中，在调整临床和病理变量后，是疾病进展的独立预后因素。
DRE 检查发现异常的前列腺肿瘤与 PCa 手术后疾病进展具有独立的不良预后。它们还提供了独立的预后信息，因为它们可能比不可触及的 PCa 更具侵袭性。
