The following is a summary of “Organ-confined pT2 ISUP4/5 vs. nonorgan confined pT3/4 ISUP2 vs. ISUP3 prostate cancer: Differences in biochemical recurrence-free survival after radical prostatectomy,” published in the July 2024 issue of Urology by Siech et al.

The study aimed to investigate the differences in biochemical recurrence (BCR) after radical prostatectomy (RP) among patients with varying pathological tumor stages (pT) and the International Society of Urological Pathologists (ISUP) grades. Specifically, it compared organ-confined pT2 ISUP4/5 with non-organ-confined pT3/4 ISUP2 and pT3/4 ISUP3 prostate cancer.

Using a tertiary-care database, the study included patients with prostate cancer who underwent RP between January 2014 and December 2021. Patients were categorized based on their pT stage and ISUP grade combination in RP specimens: pT2 ISUP4/5, pT3/4 ISUP2, and pT3/4 ISUP3. Patients with ISUP1 were excluded due to the recommendation for active surveillance, and those with pT2 ISUP2/3 or pT3/4 ISUP4/5 were excluded due to their known good and poor prognoses, respectively. Kaplan-Meier survival analyses and multivariable Cox regression models were used to evaluate BCR after RP.

Among 215 RP patients, 29 (13%) had pT2 ISUP4/5, 122 (57%) had pT3/4 ISUP2, and 64 (30%) had pT3/4 ISUP3 pathology. Three-year BCR-free survival rates were 95% for pT2 ISUP4/5, 88% for pT3/4 ISUP2, and 65% for pT3/4 ISUP3 (P < 0.001). Multivariable Cox regression analysis showed that patients with pT3/4 ISUP3 pathology had a significantly higher BCR rate compared to those with pT2 ISUP4/5 pathology (hazard ratio 3.42, 95% confidence interval 1.07-10.94; P = 0.039), whereas pT3/4 ISUP2 pathology did not show a significant difference (P = 0.6).

The study concluded that patients with prostate cancer with pT3/4 ISUP3 pathology have a higher risk of BCR after RP compared to those with pT2 ISUP4/5 pathology. As a result, closer postoperative follow-up is recommended for patients with pT3/4 ISUP3 pathology.

Source: sciencedirect.com/science/article/pii/S1078143924005453