Mortality and Additional Treatment Rates in Pathologically High-Risk Prostate Cancer With Prostate-Specific Antigen Persistence at Robot-Assisted Radical Prostatectomy: Long-Term Report From Single Tertiary Referral Center
Recommended Citation
Bertini A, Stephens A, Finocchiaro A, Viganò S, Perri A, Lughezzani G, Buffi N, Sorce G, Ficarra V, Briganti A, Salonia A, Montorsi F, Sood A, Menon M, Rogers C, and Abdollah F. Mortality and Additional Treatment Rates in Pathologically High-Risk Prostate Cancer With Prostate-Specific Antigen Persistence at Robot-Assisted Radical Prostatectomy: Long-Term Report From Single Tertiary Referral Center. Prostate 2025.
Document Type
Article
Publication Date
8-10-2025
Publication Title
The Prostate
Abstract
BACKGROUND: Long-term cancer control efficacy of robotic-assisted laparoscopic prostatectomy (RALP) in men with pathologically high-risk prostate cancer and prostate-specific antigen (PSA) persistence remains poorly addressed in the literature. Our aim was to evaluate long-term survival and additional treatment (AT) rates in these individuals.
METHODS: We included 803 patients who underwent RALP for pathologically high-risk PCa (pT ≥ 3a, pN0-1 or GG ≥ 4) between 2001 and 2022 at a single tertiary referral center (Henry Ford Hospital, Detroit). Patients without adequate information about PSA persistence were excluded from the analysis (n = 128). Kaplan-Meier curves estimated AT free-survival (ATFS) and all-cause mortality (ACM) free-survival, whereas the competing risk method was used to estimate cancer-specific mortality (CSM) free-survival, after stratification according to PSA persistence. Competing risk and Cox regression models tested the impact of PSA persistence on three endpoints: AT rates, CSM, and ACM.
RESULTS: Our final cohort consisted of 675 who underwent RALP for pathologically high-risk PCa, 187 (27.7%) of whom had PSA persistence. The median age at surgery was 64 years (IQR 59-68), and the median follow-up duration was 75 months (IQR 33-125). Patients with PSA persistence were more likely to have higher PSA values at surgery (8 vs. 7 ng/mL, p < 0.001), pT3b-4 PCa (62.5% vs. 39.9%, p < 0.001), pN1 PCa (55.6% vs. 35.7%, p < 0.001), and positive surgical margins (PSMs) (65.2% vs. 43.4%, p < 0.001). Moreover, patients in the PSA persistence group had higher proportion undergoing only hormone therapy (HT) (24.1% vs. 11.9%, p < 0.001) and radiotherapy (RT) plus HT (50.8% vs. 31.1%, p < 0.001), reporting higher median PSA values at RT (0.6 vs. 0.2 ng/mL, p < 0.001), compared to patients with undetectable PSA. At 10 years after RALP, CSM-FS and ACM-FS were 79.7% versus 90.3% (Gray-test p-value = 0.001) and 72.1% versus 79.6% (log-rank p-value = 0.013), for persistent versus undetectable PSA, respectively. The 10-year rates of ATFS were 6.6% versus 33.2% (log-rank p-value < 0.0001), for persistent versus undetectable PSA, respectively. At MVA, persistent PSA was associated with AT (HR: 3.05, p < 0.001), but not with CSM (HR: 1.49, p = 0.2) or ACM (HR: 1.09, p = 0.9).
CONCLUSION: Patients with pathologically high-risk PCa and PSA persistence after RALP, despite being at greater hazard of AT (HT and/or RT), did not have less favorable cancer control outcomes at 10 years than their counterparts with undetectable PSA levels. Our report provides the longest follow-up after RALP for this subset of patients, making it a valuable resource for counseling patients on the long-term oncologic outcomes of this procedure and postoperative adjuvant/salvage therapies.
Medical Subject Headings
PSA persistence; locally advanced; long‐term oncological outcomes; prostate cancer; robot‐assisted radical prostatectomy
PubMed ID
40785187
ePublication
ePub ahead of print
