{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:35:14Z","timestamp":1760060114799,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Objective: Adverse pathology to high-risk prostate cancer (PCa) after radical prostatectomy (upgrading) poses a threat to risk stratification and treatment planning. The impact on sexual function, urinary continence, and health-related quality of life (HRQOL) remains unclear. Methods: From 2004 to 2024, 4189 patients with preop low-\/intermediate-risk PCa (Gleason score 6 or 7a, PSA \u2264 20 ng\/mL) underwent radical prostatectomy at our department and were analyzed. Primary endpoint was HRQOL, erectile function, and urinary continence. Secondary endpoint was rate of salvage therapies and biochemical-free survival. Propensity score matching was performed using \u201coperative time\u201d, \u201crobot-assisted surgery\u201d, \u201cblood loss\u201d, \u201cnerve-sparing surgery\u201d, \u201cage\u201d, and \u201cBMI\u201d to represent comparable surgical approach. Median follow-up was 39 months (Interquartile-range (IQR) 15\u201360). Key Findings and Limitations: Patients who were upgraded to high-risk PCa showed a higher rate of postoperative radiotherapy and androgen-deprivation therapy compared to patients who were not upgraded (21% vs. 7%, p &lt; 0.001; 9% vs. 3%, p = 0.002). Five-year biochemical recurrence-free survival was 68% in the upgrading group vs. 84% in the no-upgrading group (p &lt; 0.001). We saw no difference in patient-reported HRQOL, urinary continence, or erectile function. Multivariable analysis showed that postoperative upgrading was a significant risk for not achieving good overall HRQOL (OR: 0.77, 95% CI: 0.61\u20130.97, p = 0.028) during the follow-up. Conclusions and Clinical Implications: Although postoperative upgrading to high-risk PCa leads to worse oncologic outcomes and higher salvage therapy rates, this study indicates that its impact on health-related quality of life is minimal and should not deter a cautious approach to radical prostatectomy.<\/jats:p>","DOI":"10.3390\/diagnostics15151969","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T07:45:11Z","timestamp":1754466311000},"page":"1969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adverse Pathology After Radical Prostatectomy in Low- and Intermediate-Risk Prostate Cancer: A Propensity Score-Matched Analysis of Long-Term Health-Related Quality of Life"],"prefix":"10.3390","volume":"15","author":[{"given":"Michael","family":"Chaloupka","sequence":"first","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7895-7070","authenticated-orcid":false,"given":"Alexander","family":"Buchner","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2072-5521","authenticated-orcid":false,"given":"Marc","family":"Kidess","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Ebner","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-9398","authenticated-orcid":false,"given":"Yannic","family":"Volz","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Pyrgidis","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7313-2088","authenticated-orcid":false,"given":"Stephan Timo","family":"Ledderose","sequence":"additional","affiliation":[{"name":"Institute of Pathology, LMU University, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-5447","authenticated-orcid":false,"given":"Dirk-Andr\u00e9","family":"Clevert","sequence":"additional","affiliation":[{"name":"Interdisciplinary Ultrasound Center, Department of Radiology, LMU Klinikum, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-817X","authenticated-orcid":false,"given":"Julian","family":"Marcon","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9144-9289","authenticated-orcid":false,"given":"Philipp","family":"Weinhold","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3291-9460","authenticated-orcid":false,"given":"Christian G.","family":"Stief","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Apfelbeck","sequence":"additional","affiliation":[{"name":"Department of Urology, LMU Klinikum Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. 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