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Prognostic factors among patients with pathological Grade Group 5 prostate cancer based on robot-associated radical prostatectomy specimens from a large Japanese cohort (MSUG94)

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Abstract

Purpose

There are no definitive prognostic factors for patients with pathological Grade Group 5 (pGG 5) prostate cancer (PCa) undergoing robot-associated radical prostatectomy (RARP). This study aimed to explore the prognostic factors among patients with pGG 5 PCa in a large Japanese cohort (MSUG94).

Methods

This retrospective, multi-institutional cohort study was conducted between 2012 and 2021 at ten centers in Japan and included 3195 patients. Patients with clinically metastatic PCa (cN1 or cM1) and those receiving neoadjuvant and/or adjuvant therapy were excluded. Finally, 217 patients with pGG5 PCa were analyzed.

Results

The median follow-up period was 28.0 months. The 3- and 5-year biochemical recurrence-free survival (BCRFS) rates of the overall population were 66.1% and 57.7%, respectively. The optimal threshold value (47.2%) for the percentage of positive cancer cores (PPCC) with any GG by systematic biopsy was chosen based on receiver operating characteristic curve analysis. Univariate analysis revealed that the prostate-specific antigen level at diagnosis, pT, pN, positive surgical margins (PSMs), lymphovascular invasion, and PPCC were independent prognostic factors for BCRFS. A multivariate analysis revealed that PSMs and PPCC were independent prognostic factors for BCRFS. Using these two predictors, we stratified BCRFS, metastasis-free survival (MFS), and castration-resistant PCa-free survival (CRPC-FS) among patients with pGG 5 PCa.

Conclusion

The combination of PSMs and PPCC may be an important predictor of BCRFS, MFS, and CRPC-FS in patients with pGG 5 PCa undergoing RARP.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Editage (https://www.editage.com) for English language editing.

Funding

This study received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Takeshi Sasaki & Takahiro Inoue

  2. Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Shin Ebara

  3. Department of Urology, Yokohama City University, Kanagawa, Japan

    Tomoyuki Tatenuma & Kazuhide Makiyama

  4. Department of Urology, University of Toyama, Toyama, Japan

    Yoshinori Ikehata & Hiroshi Kitamura

  5. Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan

    Akinori Nakayama & Kazutaka Saito

  6. Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan

    Makoto Kawase & Takuya Koie

  7. Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Masahiro Toide & Fumitaka Koga

  8. Department of Urology, Seirei Hamamatsu General Hospital, Shizuoka, Japan

    Tatsuaki Yoneda

  9. Department of Urology, Toranomon Hospital, Tokyo, Japan

    Kazushige Sakaguchi & Shinji Urakami

  10. Department of Urology, Kobe University Graduate School of Medicine, Hyogo, Japan

    Jun Teishima

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  1. Takeshi Sasaki
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Contributions

Takeshi Sasaki: Data collection and management, data analysis, and manuscript writing/editing. Shin Ebara: Protocol/project development and data collection and management. Tomoyuki Tatenuma: Data collection and management. Yoshinori Ikehata: Data collection and management. Akinori Nakayama: Data collection and management. Makoto Kawase: Protocol/project development and data collection and management. Masahiro Toide: Data collection and management. Tatsuaki Yoneda: Protocol/project development and data collection and management. Kazushige Sakaguchi: Data collection and management. Jun Teishima: Protocol/project development and supervision. Kazuhide Makiyama: Protocol/project development and supervision. Hiroshi Kitamura: Protocol/project development and supervision. Kazutaka Saito: Protocol/project development and supervision. Takuya Koie: Protocol/project development and supervision. Fumitaka Koga: Protocol/project development and supervision. Shinji Urakami: Protocol/project development and supervision. Takahiro Inoue: Protocol/project development, data management, and manuscript writing/editing.

Corresponding author

Correspondence to Takahiro Inoue.

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Conflict of interest

The authors declare no conflicts of interest.

Approval of the research protocol by an Institutional Reviewer Board

The protocol for this research project was approved by the suitably constituted ethics committee of each institution and conducted in accordance with the provisions of the Declaration of Helsinki (Mie University Hospital Clinical Research Ethics Committee, approval no. H2021-175).

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The requirement for informed consent was waived because the study was retrospective and observational.

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345_2024_4864_MOESM1_ESM.pdf

Supplementary file1 Supplemental Figure 1. A Kaplan–Meier analysis of BCRFS, MFS, and CRPC-FS in patients with pGG 5 stratified by PSM location based on RARP specimens. A. The 3-year BCRFS rates were 52.9%, 37.2%, 31.6%, 60.0%, and 55.6% in patients with apex-only, middle-only, bladder neck-only, seminal vesicle-only, and multifocal PSMs, respectively (P = 0.69). B. The 3-year MFS rates were 95.8%, 78.8%, 95.0%, 80.0%, and 100% in patients with apex-only, middle-only, bladder neck-only, seminal vesicle-only, and multifocal PSMs, respectively (P = 0.38). C. The 3-year CRPC-FS rates were 94.7%, 88.9%, 84.4%, 100%, and 100% in patients with apex-only, middle-only, bladder neck-only, seminal vesicle-only, and multifocal PSMs, respectively (P = 0.81). BCRFS, biochemical recurrence-free survival; MFS, metastasis-free survival; CRPC-FS, castration-resistant prostate cancer-free survival; GG, Grade Group; PSM, positive surgical margin; RARP, robot-associated radical prostatectomy (PDF 1440 KB)

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Sasaki, T., Ebara, S., Tatenuma, T. et al. Prognostic factors among patients with pathological Grade Group 5 prostate cancer based on robot-associated radical prostatectomy specimens from a large Japanese cohort (MSUG94). World J Urol 42, 152 (2024). https://doi.org/10.1007/s00345-024-04864-y

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