Evaluation of oncologic and functional outcomes after robotic-assisted radical prostatectomy performed with or without PLND for pT2 prostate cancer with Gleason score 7

Objective. To evaluate functional and oncological outcomes after radical robot-assisted prostatectomy (RRAP), performed with or without pelvic lymphadenectomy (PLND), for prostate adenocarcinoma with a Gleason score of 7 (3+4/4+3), determined based on surgical specimen examination. Material and methods. A retrospective analysis of medical records, telephone surveys, and outpatient examinations was conducted for 150 patients who underwent radical robot-assisted prostatectomy with or without PLND in the Urology Department of the A.S. Loginov Moscow State Medical Research Center between 2018 and 2021. Patients with pathological stage T2 and a histological Gleason score of 7 (3+4/4+3) were included. Biochemical recurrence criterion: at least three laboratory tests of prostate-specific antigen with a concentration≥0.2 ng/mL with exponential growth. Results. Histological examination of surgical specimens revealed pN1 in 4 of 93 patients. Of these, one patient was in the MSKCC risk group of up to 5%, and three patients were in the group greater than 5% (30%, 53%, and 60%, respectively). The maximum observation period after surgery was 70 months. During this time, biochemical recurrence was recorded in two patients in the RARP without PLND group and in seven patients in the RARP with PLND group, representing rates of 3.51% and 7.56%, respectively. The average recurrence-free survival time of patients after RARP without PLND was 42.47±11 months, in the RARP with PLND group — 40.99±12.52 months. The frequency of biochemical recurrence in patients of groups 1 and 2 did not differ statistically significantly (p=0.366). According to the results of statistical analysis carried out using the χ2 criterion and Yates’s continuity correction, there is no correlation between the development of urinary incontinence and PLND (χ2=0.10; p=0.75) with a statistically significant increase in the likelihood of developing chronic pelvic pain syndrome when performing PLND with RARP (χ2=4.28; p=0.039). In addition, an assessment of the correspondence of the Gleason sum of biopsy and surgical materials was performed to assess the accuracy of the preoperative criteria for distributing patients into a group for PLND. The histological concordance rate was 19.3% in the RARP group without PLND and 53.76% in the RARP group with PLND. In the group of patients who did not undergo PLND, 80.7% had a preoperative Gleason score lower than the actual score. Conclusion. According to the study results, PLND performed during RARP significantly increases the likelihood of developing chronic pelvic pain syndrome without affecting urinary incontinence or recurrence-free survival in patients with a Gleason score of 7. Currently, the prognostic accuracy of nomograms can be improved by adding pelvic magnetic resonance imaging results to the calculated parameters, as well as by introducing targeted prostate biopsy into routine practice to more accurately assess the key indicator—the Gleason score.