Mortality and additional treatment rates in high-risk locally advanced prostate cancer with prostate specific antigen persistence at robot-assisted radical prostatectomy: Long-term report from a single tertiary referral centre
Recommended Citation
Bertini A, Finocchiaro A, Vigano S, Cusmano N, Dinesh A, Guivatchian E, Rahimo E, Lughezzani G, Buffi N, Di Trapani E, Ficarra V, Salonia A, Briganti A, Montorsi F, Sood A, Menon M, Rogers C, Abdollah F. Mortality and additional treatment rates in high-risk locally advanced prostate cancer with prostate specific antigen persistence at robot-assisted radical prostatectomy: Long-term report from a single tertiary referral centre. Eur Urol 2025; 87(S1):1441.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Long-term cancer control efficacy of robotic-assisted laparoscopic prostatectomy (RALP) in men with locally advanced Prostate Cancer and prostate-specific-antigen (PSA) persistence remains unknown. We aimed to evaluate long-term survival and additional treatment (AT) rates in men with locally advanced PCa and PSA persistence after RALP. Materials & Methods: We included 803 patients who underwent RALP for locally advanced PCa (pT >3a, pN0-1 or GG >4) between 2001 and 2022 at a single tertiary referral centre (Henry Ford Hospital, Detroit). Patients without adequate information about PSA persistence were excluded from the analysis. Kaplan-Meier curves estimated AT free-survival, Cancer Specific Mortality (CSM) free-survival and All-cause Mortality (ACM) free-survival in the entire cohort and after stratification according to PSA persistence. 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 high-risk locally advanced PCa, 203 (33%) of whom had PSA persistence. Median age (IQR) and median follow-up time (IQR) were 64 (59-68) years and 71 (28-119) months, respectively. Patients with PSA persistence were more likely to have higher PSA values at surgery (9 vs 7 ng/mL, p<0.001), pT3b-4 PCa (62.5% vs 39.6%, p<0.001), pN1 PCa (56% vs 35%, p<0.001) and positive surgical margins (PSM) (65% vs 44%, p<0.001). Moreover, patients in the PSA persistence group had higher probability to undergo only Hormone therapy (HT) (26% vs 13%, p<0.001) and Radiotherapy (RT) plus HT (56% vs 34%, 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 15 years after RALP, AT free-survival, CSM free-survival and ACM free-survival were 2% vs 23% (p<0.0001), 81% vs 87% (p= 0.01) and 68% vs 72% (p=0.11), for persistent versus undetectable PSA, respectively. The median AT free-survival time was 6.5 vs 9.9 years for persistent versus undetectable PSA, respectively. At MVA, persistent PSA was an independent predictor of AT (HR: 1.74, p<0.001), but not of CSM (HR: 1.3, p=0.4) and ACM (HR: 0.85, p=0.5). Conclusions: Patients with high-risk locally advanced PCa and PSA persistence, despite being at greater risk of AT (HT and/or RT), did not have less favorable cancer control outcomes at 15 years. Our report provides the longest follow-up after RALP for high risk PCa with PSA persistence, making it a valuable resource for counselling patients on the long-term oncologic outcomes of this procedure.
Volume
87
Issue
S1
First Page
1441
