Introduction
Materials and methods
Data collection, patient selection, and tumor evaluation
Evaluating the prognostic impact of palpable prostate tumors
Statistical methods
Results
Demographics and oncological outcomes
Population | No PCa progression | PCa progression | Univariate analysis | ||
---|---|---|---|---|---|
HR (95% CI) | p-Value | ||||
Number (%) | 901 | 742 (82.4) | 159 (17.6) | ||
Clinical factors | |||||
Age | 65 (60–70) | 65 (60–70) | 65 (61–70) | 1.024 (1.000–1.049) | 0.053 |
BMI (kg/m2) | 25.7 (23.9–28.1) | 25.8 (23.9–28.1) | 25.6 (24–28) | 0.991 (0.942–1.043) | 0.73 |
ASA 1 | 77 (8.5) | 59 (8) | 28 (11.3) | 1 | |
ASA 2 | 743 (82.5) | 615 (82.9) | 128 (80.5) | 0.671 (0.418–1.077) | 0.098 |
ASA 3 | 81 (9.0) | 68 (9.2) | 13 (8.2) | 0.762 (0.379–1.532) | 0.445 |
PV | 40 (30–50) | 40 (30–50) | 39 (30–50) | 1.003 (0.994–1.012) | 0.550 |
PSA < 10 ng/mL | 731 (81.1) | 631 (85) | 100 (62.9) | 1 | |
PSA : 10–20 ng/mL | 132 (14.7) | 92 (13.4) | 40 (25.2) | 2.524 (1.746–3.650) | <0.0001 |
PSA > 20 ng/mL | 38 (4.2) | 19 (2.6) | 19 (11.9) | 4.291 (2.620–7.030) | <0.0001 |
BPC < 50% | 668 (74.1) | 572 (77.1) | 96 (60.4) | 1 | |
BPC ≥50% | 233 (25.9) | 170 (22.9) | 63 (39.6) | 2.225 (1.616–3.062) | <0.0001 |
cT1 | 542 (60.2) | 456 (61.5) | 86 (54.1) | 1 | |
cT2/3 | 359 (39.8) | 286 (38.5) | 73 (45.9) | 1.902 (1.389–2.605) | <0.0001 |
ISUP 1 | 343 (38.1) | 300 (40.4) | 43 (27) | 1 | |
ISUP 2/3 | 446 (49.5) | 366 (49.3) | 80 (50.3) | 2.653 (3.893) | <0.0001 |
ISUP 4/5 | 112 (12.4) | 76 (16.2) | 36 (22.6) | 4.447 (2.843–6.954) | <0.0001 |
cN0 | 851 (95.4) | 708 (95.4) | 143 (89.9) | 1 | |
cN1 | 50 (5.5) | 34 (4.6) | 16 (10.1) | 3.300 (1.959–5.559) | <0.0001 |
Pathological factors | |||||
PW | 50 (40–64) | 50 (41.7–64.2) | 53 (42–64) | 1.004 (0.096–1.012) | 0.346 |
TL | 19 (10–30) | 15 (10–30) | 20 (15–40) | 1.023 (1.015–1.031) | <0.0001 |
ISUP = 1 | 111 (12.3) | 106 (14.3) | 5 (3.1) | 1 | |
ISUP = 2/3 | 600 (66.6) | 518 (69.8) | 82 (51.6) | 5.201 (2.106–12.843) | <0.0001 |
ISUP = 4/5 | 190 (21) | 118 (15.9) | 72 (45.3) | 15.743 (6.348–39.039) | <0.0001 |
pT2 | 706 (78.4) | 618 (83.3) | 88 (55.3) | 1 | |
ECE | 88 (9.8) | 66 (8.9) | 22 (13.8) | 1.934 (1.211–3.088) | 0.006 |
SVI | 107 (11.9) | 58 (7.8) | 49 (30.8) | 4.193 (2.950–5.959) | <0.0001 |
R0 | 685 (76) | 586 (79) | 99 (62.3) | 1 | |
R1 | 216 (24) | 156 (21) | 60 (37.7) | 1.279 (1.651–3.146) | <0.0001 |
pN 0/x | 830 (92.1) | 710 (95.7) | 120 (75.5) | 1 | |
pN1 | 71 (7.9) | 32 (4.3) | 39 (24.5) | 5.549 (3.828–8.045) | <0.0001 |
Adverse prognostic impact of palpable prostate tumors on disease progression
Normal DRE | Abnormal DRE | Univariate analysis | |
---|---|---|---|
p-Value | |||
Number (%) | 542 (60.2) | 359 (39.8) | |
Clinical factors | |||
Age (years) | 65 (60–70) | 65 (61–70) | 0.220 |
BMI (kg/m2) | 26 (24.1–28.1) | 25.4 (23.7–28.1) | 0.200 |
ASA score 1 | 53 (9.8) | 24 (6.7) | 0.166 |
ASA score 2 | 445 (82.1) | 298 (83) | |
ASA score 3 | 44 (8.1) | 37 (10.3) | |
PSA < 10 (ng/mL) | 449 (82.8) | 282 (78.6) | 0.158 |
PSA 10–20 (ng/mL) | 75 (13.8) | 57 (15.9) | |
PSA < 20 (ng/mL) | 18 (3.3) | 20 (5.6) | |
PV (mL) | 40 (31–51) | 38.7 (30–49.5) | 0.076 |
BPC < 50% | 425 (78.4) | 243 (67.7) | <0.0001 |
BPC ≥ 50% | 117 (21.6) | 116 (32.3) | |
ISUP = 1 | 243 (44.8) | 100 (27.9) | <0.0001 |
ISUP = 2/3 | 264 (48.7) | 182 (50.7) | |
ISUP = 4/5 | 35 (6.5) | 77 (21.4) | |
cN0 | 527 (97.2) | 324 (90.3) | <0.0001 |
cN1 | 15 (2.8) | 35 (9.7) | |
Pathological factors | |||
PW (gr) | 52 (42–65) | 50 (41–62) | 0.066 |
TL (%) | 15 (10–25) | 20 (10–30) | <0.0001 |
ISUP = 1 | 89 (16.4) | 22 (6.1) | <0.0001 |
ISUP = 2/3 | 372 (68.4) | 228 (63.5) | |
ISUP = 4/5 | 81 (14.9) | 109 (30.4) | |
IPD (pT2) | 455 (83.9) | 251 (69.9) | <0.0001 |
ECE (pT3a) | 40 (7.4) | 48 (13.4) | |
SVI (pT3b) | 47 (8.7) | 60 (16.7) | |
R0 | 422 (77.9) | 263 (73.3) | 0.113 |
R1 | 120 (22.1) | 96 (26.7) | |
pNx/0 | 516 (95.2) | 314 (87.5) | <0.0001 |
pN1 | 26 (4.8) | 45 (12.3) |
Endpoint | Unadjusted HR (95% CI) | Clinical adjusted HR (95% CI) | Pathological adjusted HR (95% CI) |
---|---|---|---|
Population (n = 901) | |||
Non-palpable tumors | 1.000 | 1.000 | 1.000 |
Palpable tumors | 1.902 (1.389–2.605) | 1.512 (1.092–2.094) (*) | 1.497 (1.084–2.066) (**) |
Pathology ISUP ≥3 (n = 439) | |||
Non-palpable tumors | 1.000 | 1.000 | 1.000 |
Palpable tumors | 1.751 (1.217–2.519) | 1.476 (1.016–2.144) (*) | 1.612 (1.113–2.333) (***) |
Extracapsular extension (n = 88) | |||
Non-palpable tumors | 1.000 | 1.000 | 1.000 |
Palpable tumors | 3.262 (1.251–8.505) | 5.515 (1.534–19.833) (*) | 5.354 (1.840–15.583) (^) |
Seminal vesicle invasion (n = 107) | |||
Non-palpable tumors | 1.000 | 1.000 | 1.000 |
Palpable tumors | 2.278 (1.270–4.083) | 2.639 (1.322–5.231) (*) | 1.870 (1.021–3.425) (^^) |
Pelvic lymph node invasion (n = 71) | |||
Non-palpable tumors | 1.000 | 1.000 | 1.000 |
Palpable tumors | 2.609 (1.255–5.421) | 2.906 (1.302–6.487) (*) | 2.763 (1.176–6.482) (^^^) |