Preoperative Predictive Factors for Seminal Vesicle Invasion (pT3b) in Robotic‐assisted Radical Prostatectomy

Abstract

Background/Aim: Robot-assisted radical prostatectomy (RARP) outcomes improve with surgical experience, but preoperative prediction of disease stage is crucial to avoid unexpected T stage upgrades, such as pT3b. This study aimed to identify preoperative predictive factors for pT3b (seminal vesicle invasion) following RARP. Patients and Methods: Out of 299 RARP performed between 2013 and 2020, 246 cases without preoperative hormone therapy were included. Of these, 19 cases (7.7%) were pT3b. T classification was performed using magnetic resonance imaging (MRI), and 12-site prostate biopsies were conducted. Cox proportional hazards, logistic regression analysis, and Kaplan-Meier analyses were used. Results: The 3-year prostate specific antigen (PSA) recurrence-free survival rate was 87% but significantly lower at 70% for pT3b cases. Multivariate logistic regression analysis identified the International Society of Urological Pathology (ISUP) grade group at biopsy as the only significant preoperative predictor of pT3b. Conclusion: pT3b is associated with increased postoperative biochemical recurrence risk, and ISUP grade group at biopsy serves as a significant preoperative predictive factor for pT3b.