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Updated: May 28, 2026

Retzius-Sparing Robot-Assisted Radical Prostatectomy
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Outcome Differences Between Subgroups of Favorable Intermediate Risk Prostate Cancer After Radical Prostatectomy.

Matthew T Steidle1, Kamil Malshy1, Zijing Cheng1,2

  • 1Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.

The Prostate
|May 26, 2026
PubMed
Summary

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This summary is machine-generated.

Prostate cancer Grade Group 1 (GG1) tumors with intermediate risk (IR) features show similar long-term outcomes after robot-assisted radical prostatectomy (RARP). However, high PSA levels in GG1 tumors indicate outcomes similar to clinically significant disease.

Area of Science:

  • Urology
  • Oncology
  • Cancer Research

Background:

  • Prostate cancer Grade Group 1 (GG1) is typically low-risk, but D'Amico criteria classify GG1 tumors with prostate-specific antigen (PSA) 10-20 ng/mL as intermediate risk (IR).
  • This classification suggests potential heterogeneity within GG1 tumors regarding metastatic potential.

Purpose of the Study:

  • To evaluate oncologic outcomes in patients with GG1 tumors exhibiting intermediate-risk features after prostatectomy.
  • To investigate the heterogeneity of GG1 tumors within the intermediate-risk spectrum.

Main Methods:

  • Retrospective analysis of 2703 patients undergoing robot-assisted radical prostatectomy (RARP) between July 2003 and June 2023.
  • Patients were categorized into GG1-FIR (GG1 with PSA 10-20 ng/mL) and GG2-FIR (GG2 as the sole IR feature).
Keywords:
RALPcancer recurrencedisease‐free survivalprostate cancer mortalityradical prostatectomyrisk stratification

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  • Comparison of overall survival (OS), biochemical recurrence-free survival (BCRFS), time to radiotherapy, and pathological outcomes using Kaplan-Meier and Cox models.

    • Main Results:

    • Of 553 patients meeting FIR criteria, 103 were GG1-FIR and 450 were GG2-FIR.
    • No significant differences in long-term OS (15-year: 62.2% vs. 69.5%) or BCRFS (15-year: 84.2% vs. 81.2%) were observed between GG1-FIR and GG2-FIR groups.
    • Pathological outcomes, including upstaging (24.3% vs. 30.4%) and nodal positivity (3.3% vs. 2.1%), were comparable.
    • Sensitivity analysis showed GG1-FIR had similar OS but worse BCRFS compared to a low-risk cohort.

    Conclusions:

    • Patients with FIR prostate tumors demonstrate similar long-term oncologic outcomes following RARP.
    • GG1 tumors exhibit varied behavior based on PSA levels; high PSA in GG1 tumors correlates with outcomes similar to clinically significant prostate cancer.