Mortality and Additional Treatment Rates in Pathologically High-Risk Prostate Cancer With Prostate-Specific Antigen...

Area of Science:

• Urology
• Oncology
• Robotic Surgery

Background:

• Long-term cancer control after robotic-assisted laparoscopic prostatectomy (RALP) for high-risk prostate cancer (PCa) with persistent prostate-specific antigen (PSA) is not well-documented.
• This study evaluates long-term survival and additional treatment (AT) rates in patients with pathologically high-risk PCa and post-RALP PSA persistence.

Purpose of the Study:

• To assess the long-term oncologic outcomes and need for additional treatments in patients with persistent PSA after RALP for high-risk PCa.
• To provide data for counseling patients regarding the long-term efficacy of RALP and subsequent therapies.

Main Methods:

• Retrospective analysis of 675 patients who underwent RALP for pathologically high-risk PCa between 2001 and 2022.
• Patients were stratified based on PSA persistence post-surgery.
• Kaplan-Meier curves and competing risk methods were used to estimate additional treatment-free survival (ATFS), all-cause mortality (ACM)-free survival, and cancer-specific mortality (CSM)-free survival.

Main Results:

• Of 675 patients, 187 (27.7%) had PSA persistence, associated with higher baseline PSA, advanced pathological stage, and positive surgical margins.
• Patients with PSA persistence showed significantly higher rates of additional treatments (hormone therapy and/or radiotherapy) at 10 years (6.6% vs. 33.2%).
• Despite higher AT rates, 10-year cancer-specific mortality-free survival (79.7% vs. 90.3%) and all-cause mortality-free survival (72.1% vs. 79.6%) were not significantly worse in the PSA persistence group.

Conclusions:

• Patients with high-risk PCa and PSA persistence after RALP have an increased hazard of requiring additional treatments.
• However, long-term cancer control outcomes at 10 years appear comparable to those with undetectable PSA levels.
• This study offers valuable long-term follow-up data for counseling patients on RALP and postoperative therapies.