Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center

Abstract

Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018–2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D’Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.

Prognostic Significance of the Cribriform Pattern in Prostate Cancer: Clinical Outcomes and Genomic Alterations

“…These findings collectively demonstrate the prognostic significance of CP4 in prostate cancer, reinforcing its role in guiding post-surgical management and highlighting the need for a meticulous histopathological evaluation to identify CP4. Furthermore, the study by Di Mauro et al showed the critical role of pre-operative assessments, revealing that the PIRADS scores at multiparametric MRI are significant predictors of CP4 in patients undergoing RP, thereby reinforcing the necessity of incorporating advanced imaging findings to enhance the prognostic accuracy for PC patients with CP4 [28]. Our analysis supports these conclusions, demonstrating the association of CP4 with reduced PFS, thereby emphasizing the value of including this morphologic feature in the prognostic assessment of PC patients.…”

Image-Guided Prostate Cryoablation: State-of-the-Art

“…Finally, thermal ablation may play a role in patients with low- or intermediate-stage and grade prostate cancer. An increasing awareness of the potential for the overtreatment of lower-risk prostate cancer has led to several centers reporting more patients presenting with higher risk, more aggressive prostate cancer, a phenomenon known as stage migration [ 69 , 70 , 71 ]. The future research may provide additional insight into the potential role of thermal ablation in the management of patients with prostate cancer, specifically, which patients are most likely to benefit from ablative therapies.…”

The Impact of Prostate Volume on the Prostate Imaging and Reporting Data System (PI-RADS) in a Real-World Setting

“…The Prostate Imaging Reporting and Data System (PI-RADS) is the structured reporting system for the assessment of mpMRI of the prostate [ 6 ]. Beyond its potential to enable MRI-guided biopsy of the prostate, studies also showed the potential of mpMRI to predict adverse pathology at the time of radical prostatectomy [ 7 ]. However, it has been postulated that several factors may influence the PI-RADS scoring system in the detection of clinically significant prostate cancer (csPCas).…”