Oncological and Functional prognostic value of Unconventional Histology of Prostate Cancer in Localized disease treated with Robotic Radical Prostatectomy: An International Multi-Center 5-year Cohort Study

David Leung, Daniele Castellani, Rossella Nicoletti, Roser Vives Dilme, Jesus Mereno Sierra, Sergio Serni, Carmine Franzese, Giuseppe Chiacchio, Andrea Benedetto Galosi, Roberta Mazzucchelli, Erika Palagonia, Paolo Dell'Oglio, Antonio Galfano, Aldo Massimo Bocciardi, Xue Zhao, Chi Fai Ng, Hsiang-Ying Lee, Shinichi Sakamoto, Nikhil Vasdev, Juan Gomez RivasRiccardo Campi, Jeremy Yuen-Chun Teoh

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objective
The impact of prostate cancer of unconventional histology (UH) on oncological and functional outcomes after robot-assisted radical prostatectomy (RARP) and adjuvant radiotherapy (aRT) receipt is unclear. We compared the impact of cribriform pattern (CP), ductal adenocarcinoma (DAC), and intraductal carcinoma (IDC) in comparison to pure adenocarcinoma (AC) on short- to mid-term oncological and functional results and receipt of aRT after RARP.

Methods
We retrospectively collected data for a large international cohort of men with localized prostate cancer treated with RARP between 2016 and 2020. The primary outcomes were biochemical recurrence (BCR)-free survival, erectile and continence function. aRT receipt was a secondary outcome. Kaplan-Meier survival and Cox regression analyses were performed.

Key findings and limitations
A total of 3935 patients were included. At median follow-up of 2.8 yr, the rates for BCR incidence (AC 10.7% vs IDC 17%; p < 0.001) and aRT receipt (AC 4.5% vs DAC 6.3% [p = 0.003] vs IDC 11.2% [p < 0.001]) were higher with UH. The 5-yr BCR-free survival rate was significantly poorer for UH groups, with hazard ratios of 1.67 (95% confidence interval [CI] 1.16–2.40; p = 0.005) for DAC, 5.22 (95% CI 3.41–8.01; p < 0.001) for IDC, and 3.45 (95% CI 2.29–5.20; p < 0.001) for CP in comparison to AC. Logistic regression analysis revealed that the presence of UH doubled the risk of new-onset erectile dysfunction at 1 yr, in comparison to AC (grade group 1-3), with hazard ratios of 2.13 (p < 0.001) for DAC, 2.14 (p < 0.001) for IDC, and 2.01 (p = 0.011) for CP. Moreover, CP, but not IDC or DAC, was associated with a significantly higher risk of incontinence (odds ratio 1.97; p < 0.001). The study is limited by the lack of central histopathological review and relatively short follow-up.

Conclusions and clinical implications
In a large cohort, UH presence was associated with worse short- to mid-term oncological outcomes after RARP. IDC independently predicted a higher rate of aRT receipt. At 1-yr follow-up after RP, patients with UH had three times higher risk of erectile dysfunction post RARP; CP was associated with a twofold higher incontinence rate.

Patient summary
Among patients with prostate cancer who undergo robot-assisted surgery to remove the prostate, those with less common types of prostate cancer have worse results for cancer control, erection, and urinary continence and a higher probability of receiving additional radiotherapy after surgery.
Original languageEnglish
JournalEuropean urology oncology
Early online date6 Jan 2024
DOIs
Publication statusE-pub ahead of print - 6 Jan 2024

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