The impact of prostate cancer of unconventional histology (UH) on oncological and functional outcomes after robot-assisted radical prostatectomy (RARP) and adjuvant radiotherapy (aRT) receipt is unclear. We compared the impact of cribriform pattern (CP), ductal adenocarcinoma (DAC), and intraductal carcinoma (IDC) in comparison to pure adenocarcinoma (AC) on short- to mid-term oncological and functional results and receipt of aRT after RARP.
We retrospectively collected data for a large international cohort of men with localized prostate cancer treated with RARP between 2016 and 2020. The primary outcomes were biochemical recurrence (BCR)-free survival, erectile and continence function. aRT receipt was a secondary outcome. Kaplan-Meier survival and Cox regression analyses were performed.
A total of 3935 patients were included. At median follow-up of 2.8 yr, the rates for BCR incidence (AC 10.7% vs IDC 17%; p < 0.001) and aRT receipt (AC 4.5% vs DAC 6.3% [p = 0.003] vs IDC 11.2% [p < 0.001]) were higher with UH. The 5-yr BCR-free survival rate was significantly poorer for UH groups, with hazard ratios of 1.67 (95% confidence interval [CI] 1.16-2.40; p = 0.005) for DAC, 5.22 (95% CI 3.41-8.01; p < 0.001) for IDC, and 3.45 (95% CI 2.29-5.20; p < 0.001) for CP in comparison to AC. Logistic regression analysis revealed that the presence of UH doubled the risk of new-onset erectile dysfunction at 1 yr, in comparison to AC (grade group 1-3), with hazard ratios of 2.13 (p < 0.001) for DAC, 2.14 (p < 0.001) for IDC, and 2.01 (p = 0.011) for CP. Moreover, CP, but not IDC or DAC, was associated with a significantly higher risk of incontinence (odds ratio 1.97; p < 0.001). The study is limited by the lack of central histopathological review and relatively short follow-up.
In a large cohort, UH presence was associated with worse short- to mid-term oncological outcomes after RARP. IDC independently predicted a higher rate of aRT receipt. At 1-yr follow-up after RP, patients with UH had three times higher risk of erectile dysfunction post RARP; CP was associated with a twofold higher incontinence rate.
Among patients with prostate cancer who undergo robot-assisted surgery to remove the prostate, those with less common types of prostate cancer have worse results for cancer control, erection, and urinary continence and a higher probability of receiving additional radiotherapy after surgery.
European urology oncology. 2024 Jan 06 [Epub ahead of print]
David Leung, Daniele Castellani, Rossella Nicoletti, Roser Vives Dilme, Jesus Mereno Sierra, Sergio Serni, Carmine Franzese, Giuseppe Chiacchio, Andrea Benedetto Galosi, Roberta Mazzucchelli, Erika Palagonia, Paolo Dell'Oglio, Antonio Galfano, Aldo Massimo Bocciardi, Xue Zhao, Chi Fai Ng, Hsiang Ying Lee, Shinichi Sakamoto, Nikhil Vasdev, Juan Gomez Rivas, Riccardo Campi, Jeremy Yuen-Chun Teoh
Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Division of Urology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy., Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Hospital Clínico San Carlos, Madrid, Spain., Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy., Urology Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan., Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK., Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: .