Sandoval Victor, Osinski Thomas, Malshy Kamil, Feng Changyong, Joseph Jean
Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.
Prostate. 2025 Jul 31. doi: 10.1002/pros.70028.
This study aimed to investigate the long-term oncological outcomes of Grade Group (GG) 4 and 5 Prostate Cancer (PCa) diagnosed by prostate biopsy who underwent robotic-assisted radical prostatectomy (RARP).
We retrospectively reviewed our database for those who had clinically localized GG 4 and 5 PCa discovered on prostate biopsy who underwent RARP before January 1, 2018. Demographic and clinical data was collected. Primary outcomes included overall survival (OS) and PCa-specific survival (CSS). Secondary outcomes covered biochemical recurrence-free survival (BCR-FS), need for adjuvant or salvage radiotherapy (aRT/sRT), and final specimen pathological features. Kaplan-Meier analyses assessed 5-, 10-, and 15-year OS and BCR-FS.
98 patients met our inclusion criteria, with a median age of 63.7 years (IQR: 59.7-69.3) and a median preoperative PSA level of 6.9 ng/mL (IQR: 4.9-10.9). Most patients were GG 4 (77.6%), and 22.4% were GG 5. Pathology at prostatectomy revealed the following ISUP Grade Groups: 19 patients (19.4%) with Grade Group 2, 36 (36.7%) with Grade Group 3, 27 (27.6%) with Grade Group 4, and 16 (16.3%) with Grade Group 5. 64.2% had pT3 (or greater?) disease, 21.4% with pN+, and 22.4% with positive margins. 26.5% of patients received post-RARP radiotherapy (14.3% adjuvant, 12.5% salvage). After a median follow-up of 132 months, 12 deaths occurred (none from prostate cancer; CSS = 100%]). OS estimates were 95% at 5 years, 88% at 10 years, and 86% at 15 years. The estimated BCRFS rates were 90%, 80%, and 78% at 5, 10, and 15 years respectively.
In our cohort, RARP for clinically localized GG 4 and 5 PCa discovered on prostate biopsy achieved high OS, CSS, and BCFRS rates with mostly single-modality treatment. RARP remains a valid first-line treatment for clinically localized GG 4 and 5 PCa.
本研究旨在调查经前列腺穿刺活检诊断为4级和5级前列腺癌（PCa）并接受机器人辅助根治性前列腺切除术（RARP）患者的长期肿瘤学结局。
我们回顾性分析了2018年1月1日前接受RARP的前列腺穿刺活检发现临床局限性4级和5级PCa患者的数据库。收集了人口统计学和临床数据。主要结局包括总生存期（OS）和PCa特异性生存期（CSS）。次要结局包括无生化复发生存期（BCR-FS）、辅助或挽救性放疗（aRT/sRT）的需求以及最终标本的病理特征。采用Kaplan-Meier分析评估5年、10年和15年的OS和BCR-FS。
98例患者符合纳入标准，中位年龄63.7岁（四分位间距：59.7-69.3），术前中位PSA水平为6.9 ng/mL（四分位间距：4.9-10.9）。大多数患者为4级（77.6%），22.4%为5级。前列腺切除术后病理显示以下国际泌尿病理学会（ISUP）分级组：19例（19.4%）为2级，36例（36.7%）为3级，27例（27.6%）为4级，16例（16.3%）为5级。64.2%患者有pT3（或更高？）期疾病，21.4%有pN+，22.4%切缘阳性。26.5%的患者接受了RARP术后放疗（14.3%辅助放疗，12.5%挽救性放疗）。中位随访132个月后，发生12例死亡（均非前列腺癌死亡；CSS = 100%）。5年、10年和15年的OS估计分别为95%、88%和86%。5年、10年和15年的BCRFS估计率分别为90%、80%和78%。
在我们的队列中，对于前列腺穿刺活检发现的临床局限性4级和5级PCa，RARP大多采用单一治疗方式，可实现较高的OS、CSS和BCFRS率。RARP仍然是临床局限性4级和5级PCa的有效一线治疗方法。
