Deivasigamani Sriram, Adams Eric S, Stock Shannon, Kotamarti Srinath, Séguier Denis, Taha Tarek, Howard Lauren E, Aminsharifi Alireza, Jibara Ghalib, Amling Christopher L, Aronson William J, Cooperberg Matthew R, Kane Christopher J, Terris Martha K, Klaassen Zachary, Guerrios-Rivera Lourdes, Freedland Stephen J, Polascik Thomas J
Department of Urology, Duke University Medical Center, Durham, NC, USA.
Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA.
Prostate Cancer Prostatic Dis. 2024 Aug 12. doi: 10.1038/s41391-024-00880-6.
Partial gland ablation (PGA) is increasingly popular as a treatment for men with intermediate-risk prostate cancer (IR-PCa) to preserve functional outcomes while controlling their cancer. We aimed to determine the impact of race and clinical characteristics on the risk of upstaging (≥pT2c) and having adverse pathological outcomes including seminal vesicle invasion (SVI), extra prostatic extension (EPE) and lymph node invasion (LNI) at radical prostatectomy (RP) among men with IR disease eligible for PGA with hemi-ablation (HA).
Retrospective analysis.
Multicenter.
We studied patients diagnosed with unilateral IR-PCa treated with RP between 1988 and 2020 at 9 different Veterans Affairs hospitals within the SEARCH cohort. We analyzed differences in clinicopathological characteristics and outcome variables (odds of ≥pT2c and SVI, EPE and LNI) by race using multivariable logistic regression after adjusting for covariates.
Among 3127 patients, 33% were African American (AA) men with unilateral IR-PCa undergoing RP. Compared to non-AA men, AA individuals were younger (61 vs. 65 years, p < 0.001), presented with a higher prostate specific antigen (PSA) category (≥10 ng/ml; 34 vs. 26%, p < 0.001), and had a lower clinical stage (p < 0.001). Among the 2,798 (89.5%) with ≥pT2c stage, AA men exhibited higher ≥ pT2c rates (93 vs. 89%, p < 0.001), primarily due to increased pT2c staging (64 vs. 57%), where upstaging beyond pT2 was lower than non-AA men (29 vs. 32%). On multivariable analysis, AA men were found to have higher odds of ≥pT2c (odds ratio [OR]: 1.39 CI, 1.02-1.88, p = 0.04), lower odds of EPE (OR: 0.73 CI, 0.58-0.91, p < 0.01) and no statistically significant associations with LNI (OR: 0.79 CI, 0.42-1.46, p = 0.45) and SVI (OR: 1 CI, 0.74-1.35, p = 0.99) compared to non-AA men. On multivariable analysis, clinical features associated with higher odds of ≥pT2c were pre-operative PSA ≥ 15 (OR = 2.07, P = 0.01) and higher number of positive cores (HPC) on biopsy (OR = 1.36, P < 0.001). Similarly, PSA ≥ 15, Gleason grade ≥3 and HPC on biopsy were associated with higher odds of SVI, EPE and LNI, respectively.
In men with IR-PCa undergoing RP, AA men demonstrated an overall higher likelihood of ≥pT2c with lower upstaging beyond pT2, lower likelihood of EPE and no significant difference in likelihood of SVI and LNI compared to non-AA men. These findings support select AA men to be potential candidates for PGA, such as HA. Clinical factors are predictive of higher pathological stage and adverse pathological outcomes at RP and could be considered when selecting candidates for PGA.
部分腺体消融（PGA）作为一种治疗中度风险前列腺癌（IR-PCa）男性患者的方法越来越受欢迎，旨在在控制癌症的同时保留功能结果。我们旨在确定种族和临床特征对符合半消融（HA）PGA治疗的IR疾病男性患者在根治性前列腺切除术（RP）时分期升级（≥pT2c）以及出现包括精囊侵犯（SVI）、前列腺外扩展（EPE）和淋巴结侵犯（LNI）等不良病理结果风险的影响。
回顾性分析。
多中心。
我们研究了1988年至2020年期间在SEARCH队列中的9家不同退伍军人事务医院接受RP治疗的单侧IR-PCa患者。在调整协变量后，我们使用多变量逻辑回归分析了种族在临床病理特征和结局变量（≥pT2c以及SVI、EPE和LNI的几率）方面的差异。
在3127例患者中，33%为接受RP治疗的单侧IR-PCa非裔美国（AA）男性。与非AA男性相比，AA个体更年轻（61岁对65岁，p < 0.001），前列腺特异性抗原（PSA）类别更高（≥10 ng/ml；34%对26%，p < 0.001），且临床分期更低（p < 0.001）。在2798例（89.5%）≥pT2c期患者中，AA男性的≥pT2c率更高（93%对89%，p < 0.001），主要是由于pT2c分期增加（64%对57%），其中超过pT2的分期升级低于非AA男性（29%对32%）。多变量分析发现，与非AA男性相比，AA男性≥pT2c的几率更高（优势比[OR]：1.39，置信区间[CI]：1.02 - 1.88，p = 0.04），EPE的几率更低（OR：0.73，CI：0.58 - 0.91，p < 0.01），与LNI（OR：0.79，CI：0.42 - 1.46，p = 0.45）和SVI（OR：1，CI：0.74 - 1.35，p = 0.99）无统计学显著关联。多变量分析显示，与≥pT2c几率较高相关的临床特征为术前PSA≥15（OR = 2.07，P = 0.01）和活检时阳性核心数（HPC）较多（OR = 1.36，P < 0.001）。同样，PSA≥15、Gleason分级≥3和活检时的HPC分别与SVI、EPE和LNI的较高几率相关。
在接受RP治疗的IR-PCa男性患者中，与非AA男性相比，AA男性总体上≥pT2c的可能性更高，超过pT2的分期升级更低，EPE可能性更低，SVI和LNI可能性无显著差异。这些发现支持选择部分AA男性作为PGA（如HA）的潜在候选者。临床因素可预测RP时更高的病理分期和不良病理结果，在选择PGA候选者时可予以考虑。
