Mp58-10 Modeling the Oncological Outcomes of Partial Prostatectomy in a Cohort of Patients Who Underwent Radical Prostatectomy for Localized Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP58)1 May 2024MP58-10 MODELING THE ONCOLOGICAL OUTCOMES OF PARTIAL PROSTATECTOMY IN A COHORT OF PATIENTS WHO UNDERWENT RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER Adriana M. Pedraza Bermeo, Jaya S. Chavali, Carter Mikesell, Roxana Ramos-Carpinteyro, Nicolas Soputro, and Jihad Kaouk Adriana M. Pedraza BermeoAdriana M. Pedraza Bermeo , Jaya S. ChavaliJaya S. Chavali , Carter MikesellCarter Mikesell , Roxana Ramos-CarpinteyroRoxana Ramos-Carpinteyro , Nicolas SoputroNicolas Soputro , and Jihad KaoukJihad Kaouk View All Author Informationhttps://doi.org/10.1097/01.JU.0001008852.83523.41.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long-term follow-up studies consistently show that localized prostate cancer patients on active surveillance have survival rates similar to those receiving radical treatments. However, this comes with a higher risk of metastatic disease and increased need for hormonal therapy. Given the dominant lesion's role in metastatic progression and the importance of preserving post-treatment function, interest in focal therapies and organ-sparing surgery is growing. Yet, due to prostate cancer's multifocal nature, questions persist about the oncologic safety of these methods. Our objective is to identify predictive factors for overlooking cancer foci during Partial Prostatectomy (PP). METHODS: We simulated PP using quarter-mount prostate samples from 64 men who underwent radical prostatectomy from August 2014 to August 2023 and met the PP criteria: PSA≤10 ng/ml, clinical stage ≤T2b, ISUP Grade Group≤2, and a unilateral dominant lesion on mpMRI with matching positive biopsies. Data were prospectively collected in an IRB-approved database, followed by a retrospective analysis. RESULTS: At diagnosis, median age was 64 (IQR 53-78) and PSA was 5.5 ng/mL (IQR 1-10). The upgrading and upstaging rates were 40% (26/64) and 46% (30/64), respectively. PP would have left residual cancer in 25% (16/64) of cases. Factors predicting missed cancer included cribriform architecture, >45% positive cores, mpMRI lesion length ≤14 mm, and prostate volume ≤36 cc (AUC=0.86). While mpMRI found the dominant lesion in 89% (57/64) of patients, it underestimated size in 70%, with a 4.5 mm mean discrepancy between radiological (13.2 mm) and pathological (17.7 mm) measurements. Most of the missed cancers would have been located in the contralateral peripheral zone and at the prostate apex. CONCLUSIONS: PP offers an appealing option for managing localized prostate cancer in selected patients. The risk of overlooking cancerous foci—particularly in those with cribriform architecture and a significant proportion of positive biopsy cores—should not be underestimated. Given the inherent limitations of mpMRI in sizing the tumor, rigorous assessment of safety margins becomes imperative. Our study underscores variables warranting attention in the execution of these tailored interventions. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e950 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Adriana M. Pedraza Bermeo More articles by this author Jaya S. Chavali More articles by this author Carter Mikesell More articles by this author Roxana Ramos-Carpinteyro More articles by this author Nicolas Soputro More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...