Long-term oncological outcomes of prostate cancer upgrading following robot-assisted radical prostatectomy.

351 Background: Pathologic upgrading from biopsy to final pathology at the time of Robot-Assisted Radical Prostatectomy (RARP) is a frequent finding and may reflect more aggressive disease biology, potentially leading to adverse long-term oncologic outcomes. This study aimed to evaluate the association between upgrading and oncologic outcomes beyond five years after RARP. Methods: A retrospective review was conducted using an IRB-approved database to identify 4,910 consecutive patients who underwent RARP between 2015 and 2020. Patients were included if they had at least five years of postoperative follow-up. Biochemical recurrence (BCR) was defined according to AUA guidelines. Results: A total of 1,210 patients met inclusion criteria. Pathologic upgrading was identified in 361 patients (29.8%). While the upgraded and non-upgraded groups were similar in terms of adverse pathological features, the upgraded group had a significantly higher incidence of positive surgical margins (42.1% vs. 35.4%, p = 0.039). At a median follow-up of 82.4 months (IQR 69.5-97.4), these differences did not translate into a significant difference in BCR-free survival ( p = 0.32). Conclusions: Despite a relatively high incidence of pathologic upgrading in patients undergoing RARP, most of which originated from Grade Group 1, this finding was not associated with worse BCR outcomes. With long term follow-up, upgrading at the time of RARP did not significantly impact BCR-free survival, and overall BCR rates did not differ meaningfully between upgraded and non-upgraded patients. Baseline clinicodemographics and oncological outcomes of all included patients. Overall cohort ( n =1210) Equivocal ( n =841) Upgrading ( n =361) p Age (years) 63 (58 –68) 63 (59-68) 63 (58-67) 0.077 PSA (ng/mL) 5.7 (4.2 - 8.6) 6.5 (4.8-11.6) 7.3 (5.2-11.5) 0.201 Biopsy ISUP Grade Group <0.001 1 256 (21.2%) 66 (7.9%) 188 (52.1%) 2 517 (42.7%) 405 (48.2%) 108 (29.9%) 3 234 (19.3%) 195 (23.2%) 42 (11.6%) 4-5 203 (16.8%) 178 (21.1%) 25 (6.9%) RARP ISUP Grade Group <0.001 1 70 (5.8%) 70 (8.3%) 0 2 639 (53.2%) 474 (56.4%) 165 (45.5%) 3 300 (25.0%) 188 (22.4%) 112 (32.0%) 4 78 (6.5%) 51 (6.1%) 27 (7.5%) 5 <jats:td colspan