Sasaki Takeshi, Igarashi Atsushi, Ebara Shin, Tatenuma Tomoyuki, Ikehata Yoshinori, Nakayama Akinori, Kawase Makoto, Toide Masahiro, Yoneda Tatsuaki, Sakaguchi Kazushige, Teishima Jun, Makiyama Kazuhide, Kitamura Hiroshi, Saito Kazutaka, Koie Takuya, Koga Fumitaka, Urakami Shinji, Yamasaki Toshinari, Inoue Takahiro
Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Int J Urol. 2026 Feb;33(2):e70370. doi: 10.1111/iju.70370.
To explore clinicopathological risk factors associated with the development of castration-resistant prostate cancer (CRPC) in patients who underwent robot-assisted radical prostatectomy (RARP).
This study was conducted in nine Japanese institutions between 2012 and 2021. Patients with clinically metastatic PCa, those who received neoadjuvant or adjuvant therapy, were excluded. Consequently, 2825 patients with PCa were analyzed. Persistent prostate-specific antigen (PSA) was determined as a level ≥ 0.2 ng/mL at 1 month postoperatively and consistently in subsequent measurements.
Median follow-up was 42.0 months. Under follow-up, 493 (17.4%) and 25 (0.8%) patients progressed to biochemical recurrence and CRPC, respectively. One hundred and ninety-six patients received salvage radiation therapy, and 229 patients received salvage androgen deprivation therapy. Among the 25 patients with CRPC, the median time to CRPC was 31.8 months. Univariate analysis revealed that preoperative PSA level, biopsy grade group (GG) 5, percentage of positive cancer cores, GG5 in RARP specimens, pT3b, pN1, positive surgical margins, lymphovascular invasion (LVI), and persistent PSA levels were associated with CRPC development. Multivariate analysis revealed that biopsy GG5 (adjusted hazard ratio [aHR] 12.74, p < 0.001), LVI (aHR 3.90, p = 0.011), and persistent PSA levels (aHR 8.66, p < 0.001) were independently associated with CRPC development. Furthermore, using these three factors made it possible to stratify CRPC-free survival among patients with PCa who received RARP and confirmed external validation.
The combination of biopsy GG5, LVI, and persistent PSA levels may stratify the risk of developing CRPC in patients with PCa undergoing RARP.
探讨接受机器人辅助根治性前列腺切除术（RARP）的患者中与去势抵抗性前列腺癌（CRPC）发生相关的临床病理危险因素。
本研究于2012年至2021年在日本的9家机构进行。排除临床转移性前列腺癌患者以及接受新辅助或辅助治疗的患者。最终，对2825例前列腺癌患者进行了分析。持续性前列腺特异性抗原（PSA）定义为术后1个月时≥0.2 ng/mL且在随后的测量中持续如此。
中位随访时间为42.0个月。在随访期间，分别有493例（17.4%）和25例（0.8%）患者进展为生化复发和CRPC。196例患者接受了挽救性放射治疗，229例患者接受了挽救性雄激素剥夺治疗。在25例CRPC患者中，发生CRPC的中位时间为31.8个月。单因素分析显示，术前PSA水平、活检分级组（GG）5、癌灶阳性百分比、RARP标本中的GG5、pT3b、pN1、手术切缘阳性、淋巴管浸润（LVI）和持续性PSA水平与CRPC的发生相关。多因素分析显示，活检GG5（调整后风险比[aHR] 12.74，p < 0.001）、LVI（aHR 3.90，p = 0.011）和持续性PSA水平（aHR 8.66，p < 0.001）与CRPC的发生独立相关。此外，使用这三个因素能够对接受RARP且经外部验证的前列腺癌患者的无CRPC生存期进行分层。
活检GG5、LVI和持续性PSA水平的组合可能对接受RARP的前列腺癌患者发生CRPC的风险进行分层。
