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.
Journal of robotic surgery. 2023 Jul 24 [Epub ahead of print]
Antonio Benito Porcaro, Sebastian Gallina, Alberto Bianchi, Alessandro Tafuri, Emanuele Serafin, Andrea Panunzio, Giovanni Mazzucato, Rossella Orlando, Francesco Ditonno, Paola Irene Ornaghi, Riccardo Rizzetto, Clara Cerrato, Vincenzo De Marco, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, Alessandro Antonelli
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy. ., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy., Department of Urology, Vito Fazzi Hospital, Lecce, Italy., Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy.