Functional outcomes of robot-assisted radical prostatectomy in patients eligible for active surveillance

Can systemic immune-inflammation index and hematologic parameters aid in decision-making for active surveillance or curative treatment in low-risk prostate cancer?

INTRODUCTION

Pathologic Gleason Score (GS) upgrading is common in patients with low-risk localized prostate cancer (PCa) who are followed by active surveillance (AS) or undergo radical prostatectomy (RP). This fact raises concerns about inadequate treatment, especially in AS patients. We aimed to analyze the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation (SII) index with GS upgrading.

MATERIALS AND METHODS

This study was approved by the Ethical Review Committee of Afyonkarahisar Health Sciences University. Data of the patients who underwent RP for PCa at three different centers between 2018 and 2023 were retrospectively analyzed. The patients were divided into 2 groups based on GR upgrading status as "upgrading" and "non-upgrading". Among the patients who underwent RP, 77 patients who fully met the criteria for AS were identified. The patients eligible for AS were divided into "non-upgrading" and "upgrading" groups. These groups were compared regarding NLR, PLR, and SII index values.

RESULTS

Overall, data from 250 patients were reviewed. Among these, 147 had GS upgrading, while 103 had no upgrading. Seventy-seven patients were eligible for AS. Among these patients, 30 had upgrading, while 47 were in the "non-upgrading" group. Our analysis revealed that an NLR of 1.85 and above was associated with a 2.238-fold increase in the risk of GS upgrading (p = 0.009). Also, a PLR of 115.7 and above was affiliated with a 2.992-fold increase in the GS upgrading risk (p < 0.001). The analysis regarding patients who underwent RP but were eligible for AS revealed that an NLR of ≥1.68 was associated with a 3.25-fold risk increase in GS upgrading. On the other hand, a PLR≥134.5 and an SII index≥630.7 were affiliated with a 12.303-fold and 6.562-fold increase in the risk of upgrading (p = 0.019, p = 0.018).

CONCLUSION

The decision of AS should be carefully reappraised, and treatment methods such as RP or radiotherapy should be considered in patients with high NLR, PLR, or SII index values.

Old men with prostate cancer have higher risk of Gleason score upgrading and pathological upstaging after initial diagnosis: a systematic review and meta-analysis

BACKGROUND

To evaluate the predictive performance of age for the risk of Gleason score change and pathologic upstaging.

EVIDENCE ACQUISITION

Ovid MEDLINE, Ovid Embase, and the Cochrane Library were searched from inception until May 2020. Quality of included studies was appraised utilizing the Newcastle-Ottawa Quality Assessment Scale for case-control studies. The publication bias was evaluated by funnel plots and Egger's tests.

EVIDENCE SYNTHESIS

Our search yielded 27 studies with moderate-to-high quality including 84296 patients with mean age of 62.1 years. From biopsy to prostatectomy, upgrading and upstaging occurred in 32.3% and 9.8% of patients, respectively. Upgrading from diagnostic biopsy to confirmatory biopsy was found in 16.8%. Older age was associated with a significant increased risk of upgrading (OR 1.04, 95% CI 1.03-1.05), and similar direction of effect was found in studies focused on upgrading from diagnostic biopsy to confirmatory biopsy (OR 1.06, 95% CI 1.04-1.08). For pathologic upstaging within older men compared with younger, the pooled odds was 1.03 (95% CI 1.01-1.04).

CONCLUSION

Thorough consideration of age in the context of effect sizes for other factors not only prompts more accurate risk stratification but also helps providers to select optimal therapies for patients with prostate cancer.