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).