{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T09:23:51Z","timestamp":1762853031656,"version":"build-2065373602"},"reference-count":34,"publisher":"Wiley","issue":"16","license":[{"start":{"date-parts":[[2025,8,10]],"date-time":"2025-08-10T00:00:00Z","timestamp":1754784000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long\u2010term cancer control efficacy of robotic\u2010assisted laparoscopic prostatectomy (RALP) in men with pathologically high\u2010risk prostate cancer and prostate\u2010specific antigen (PSA) persistence remains poorly addressed in the literature. Our aim was to evaluate long\u2010term survival and additional treatment (AT) rates in these individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We included 803 patients who underwent RALP for pathologically high\u2010risk PCa (pT\u2009\u2265\u20093a, pN0\u20101 or GG\u2009\u2265\u20094) between 2001 and 2022 at a single tertiary referral center (Henry Ford Hospital, Detroit). Patients without adequate information about PSA persistence were excluded from the analysis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009128). Kaplan\u2013Meier curves estimated AT free\u2010survival (ATFS) and all\u2010cause mortality (ACM) free\u2010survival, whereas the competing risk method was used to estimate cancer\u2010specific mortality (CSM) free\u2010survival, after stratification according to PSA persistence. Competing risk and Cox regression models tested the impact of PSA persistence on three endpoints: AT rates, CSM, and ACM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our final cohort consisted of 675 who underwent RALP for pathologically high\u2010risk PCa, 187 (27.7%) of whom had PSA persistence. The median age at surgery was 64 years (IQR 59\u201368), and the median follow\u2010up duration was 75 months (IQR 33\u2013125). Patients with PSA persistence were more likely to have higher PSA values at surgery (8 vs. 7\u2009ng\/mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), pT3b\u20104 PCa (62.5% vs. 39.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), pN1 PCa (55.6% vs. 35.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and positive surgical margins (PSMs) (65.2% vs. 43.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Moreover, patients in the PSA persistence group had higher proportion undergoing only hormone therapy (HT) (24.1% vs. 11.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and radiotherapy (RT) plus HT (50.8% vs. 31.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), reporting higher median PSA values at RT (0.6 vs. 0.2\u2009ng\/mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), compared to patients with undetectable PSA. At 10 years after RALP, CSM\u2010FS and ACM\u2010FS were 79.7% versus 90.3% (Gray\u2010test\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value\u2009=\u20090.001) and 72.1% versus 79.6% (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value\u2009=\u20090.013), for persistent versus undetectable PSA, respectively. The 10\u2010year rates of ATFS were 6.6% versus 33.2% (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value\u2009&lt;\u20090.0001), for persistent versus undetectable PSA, respectively. At MVA, persistent PSA was associated with AT (HR: 3.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), but not with CSM (HR: 1.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2) or ACM (HR: 1.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.9).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with pathologically high\u2010risk PCa and PSA persistence after RALP, despite being at greater hazard of AT (HT and\/or RT), did not have less favorable cancer control outcomes at 10 years than their counterparts with undetectable PSA levels. Our report provides the longest follow\u2010up after RALP for this subset of patients, making it a valuable resource for counseling patients on the long\u2010term oncologic outcomes of this procedure and postoperative adjuvant\/salvage therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70031","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T05:35:01Z","timestamp":1754890501000},"page":"1457-1467","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality and Additional Treatment Rates in Pathologically High\u2010Risk Prostate Cancer With Prostate\u2010Specific Antigen Persistence at Robot\u2010Assisted Radical Prostatectomy: Long\u2010Term Report From Single Tertiary Referral Center"],"prefix":"10.1002","volume":"85","author":[{"given":"Alessandro","family":"Bertini","sequence":"first","affiliation":[{"name":"VUI Center for Outcomes Research, Analysis, and Evaluation Henry Ford Health System Detroit Michigan USA"},{"name":"Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Stephens","sequence":"additional","affiliation":[{"name":"Public Health Sciences Henry Ford Health System Detroit Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessio","family":"Finocchiaro","sequence":"additional","affiliation":[{"name":"VUI Center for Outcomes Research, Analysis, and Evaluation Henry Ford Health System Detroit Michigan USA"},{"name":"Department of Urology, IRCCS Humanitas Research Hospital Humanitas University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Vigan\u00f2","sequence":"additional","affiliation":[{"name":"VUI Center for Outcomes Research, Analysis, and Evaluation Henry Ford Health System Detroit Michigan USA"},{"name":"Department of Clinical and Experimental Medicine, Department of Oncology, Urologic Section, AOU G. Martino University of Messina Messina Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Perri","sequence":"additional","affiliation":[{"name":"VUI Center for Outcomes Research, Analysis, and Evaluation Henry Ford Health System Detroit Michigan USA"},{"name":"Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3939-4521","authenticated-orcid":false,"given":"Giovanni","family":"Lughezzani","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Humanitas Research Hospital Humanitas University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicol\u00f2","family":"Buffi","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Humanitas Research Hospital Humanitas University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2436-2412","authenticated-orcid":false,"given":"Gabriele","family":"Sorce","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Department of Oncology, Urologic Section, AOU G. Martino University of Messina Messina Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Ficarra","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Department of Oncology, Urologic Section, AOU G. Martino University of Messina Messina Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Briganti","sequence":"additional","affiliation":[{"name":"Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-7165","authenticated-orcid":false,"given":"Andrea","family":"Salonia","sequence":"additional","affiliation":[{"name":"Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele Vita\u2010Salute San Raffaele University Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Montorsi","sequence":"additional","affiliation":[{"name":"Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele Vita\u2010Salute San Raffaele University Milan 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Center for Outcomes Research, Analysis, and Evaluation Henry Ford Health System Detroit Michigan USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000049751"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/17434440.2020.1762487"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009625.pub2"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2023.08.005"},{"volume-title":"EAU\u2010EANM\u2010ESTRO\u2010ESUR\u2010ISUP\u2010SIOG Guidelines on Prostate Cancer","year":"2024","author":"Cornford 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