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Clinical Tools for Optimizing Therapeutic Decision-Making in Prostate Cancer: A Five-Year Retrospective Analysis.

Silviu Constantin Latcu1,2, Alin Adrian Cumpanas2, Vlad Barbos1

  • 1Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.

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|July 27, 2024
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Summary

Accurate preoperative prostate cancer staging, using tools like Gleason score and MRI, is crucial for predicting outcomes and guiding treatment after surgery. High-risk patients showed the most significant changes in staging post-surgery, emphasizing the need for detailed preoperative assessment.

Keywords:
clinical predictive toolsdiagnosishistopathologyimagingmortalityprognosisprostate cancerradical prostatectomyrisk stratificationsurgical treatment

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Area of Science:

  • Urology
  • Oncology
  • Medical Imaging

Background:

  • Effective prostate cancer staging is critical for treatment planning and prognosis.
  • Preoperative diagnostic accuracy influences postoperative outcomes and patient management.
  • Accurate restaging post-prostatectomy is essential for refining treatment strategies.

Purpose of the Study:

  • To assess the correlation between detailed preoperative diagnostic scores and postoperative outcomes in prostate cancer patients.
  • To evaluate the accuracy of preoperative assessments in predicting cancer restaging and its impact on prognosis.
  • To analyze the influence of preoperative scores (Gleason, CAPRA, PIRADS, MRI findings) on postoperative pathological findings and staging.

Main Methods:

  • Retrospective analysis of 133 prostate cancer patients undergoing prostatectomy.
  • Comparison of preoperative and postoperative Gleason scores across different risk categories.
  • Evaluation of changes in clinical staging (NCCN risk, ISUP grade, nodal status) and MRI-detected adenopathy.
  • Correlation analysis between preoperative scores (CAPRA, PIRADS, Gleason, biopsy fragments) and postoperative outcomes (ISUP grade, pathological findings).
  • Assessment of predictive values (AUC) for preoperative PSA, Gleason score, and positive biopsy fragments in forecasting cancer aggressiveness.

Main Results:

  • Preoperative and postoperative Gleason scores significantly increased, particularly in high-risk patients (average increase of 0.76).
  • High-risk patients exhibited significant increases in NCCN risk (30%), ISUP grade (26.7%), and nodal status (23.3%).
  • Preoperative CAPRA and PIRADS scores showed significant correlations with postoperative ISUP grade (r=0.261 and r=0.306, respectively).
  • Preoperative MRI findings, including adenopathy, correlated significantly with postoperative pathological findings (r=0.218).
  • Preoperative PSA levels demonstrated the highest AUC (0.631) in forecasting cancer aggressiveness post-surgery.

Conclusions:

  • Detailed preoperative assessments, including Gleason score, CAPRA, PIRADS, and MRI findings, are vital for accurate prostate cancer staging and prognosis prediction.
  • Preoperative diagnostic tools significantly correlate with postoperative pathological outcomes, aiding in treatment decision-making.
  • Enhancing preoperative staging accuracy can lead to more personalized treatment strategies and improved patient outcomes following prostatectomy.