RESULTS
A total of 290 patients were stratified into Group A (n = 144) and Group
B (n = 146). The mean age of the patients was 63.9 ± 7.9 years, and the
median PSA value was 6.49 ng/dL (range: 4.7-9.5 ng/dL). According to the
mpMRI examination, 17 (5.9%) cases were evaluated as PI-RADS 2, 77
(26.6%) as PI-RADS 3, 165 (56.9%) as PI-RADS 4, and 31 (10.7%) as
PI-RADS 5. The fusion biopsy results revealed the detection rates of
ISUP Grade 1, 2, 3, 4 and 5 to be 65 (22.4%), 51 (17.6%), 34 (11.7%),
13 (4.5%), and 6 (2.1% ), respectively. RALP was performed in 53
(18.3%) of the patients included in the study, who underwent a fusion
biopsy. The histopathological analysis of these cases after RALP showed
that 22 (41.5%) patients had EPE, 16 (30.1%) had SM positivity and
four (7.5%) had SVI positivity. The demographic findings of the
patients are shown in Table 1.
When the patients were evaluated according to the mpMRI lesion size, it
was observed that the PSAD value was statistically significantly higher
in Group B than in Group A (p = 0.012). The PI-RADS score was also
higher in Group B compared to Group A, and the two groups statistically
significantly differed in terms of clinical T-stage (p < 0.001
and p <0.001, respectively). According to the fusion biopsy
results, the rate of PCa detection and the number of positive cores were
statistically significantly higher in Group B than in group A (p = 0.001
and p = 0.007, respectively). In addition, there was a statistically
significant difference between the biopsy-ISUP grade values of the two
groups (p <0.001). Another significant difference was detected
in relation to the presence of clinically significant PCa (p
<0.001). While the rate of csPCa detection among all biopsies
was 62.3% in Group B, it was determined to be 38.9% in Group A. The
rate of cisPCa detection was statistically similar in the two groups
(Table 2).
It was observed that the pathological T-stage in the patients who
underwent RALP was more advanced in Group B (p = 0.003). In addition,
the EPE and SM positivity rates were higher in Group B compared to Group
A (p = 0.001 and p = 0.004, respectively). The two groups were
statistically similar in terms of preoperative clinical stage, ISUP
grade of specimen pathology, Gleason upgrade rate, and SVI and LNM
detection rates among the patients who underwent RALP (Table 3).
Possible variables associated with EPE positivity after RALP (age, PSA,
PSAD, biopsy-ISUP grade, number of positive cores, clinical T-stage, and
mpMRI lesion size) were evaluated using the univariate analysis, and the
mpMRI lesion size being >10 mm was determined to be
significant in predicting EPE positivity. The multivariate analysis
revealed only the mpMRI lesion size being >10 mm as an
independent predictor of EPE positivity. According to the univariate
analysis of the possible variables associated with SM positivity (age,
PSA, PSAD, PI-RADS, biopsy-ISUP grade, number of positive cores,
clinical T-stage, Damigo risk group, and mpMRI lesion size), the mpMRI
lesion size being >10 mm and the presence of biopsy-ISUP
grade 2 significantly predicted SM positivity. In the multivariate
analysis, the mpMRI lesion size being >10 mm was found to
be an independent predictive factor for SM positivity (Table 4).