Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations

BACKGROUND: Accurate assessment of the clinical staging is crucial for determining the need for radical prostatectomy (RP) in prostate cancer (PCa). However, the current methods for PCa staging may yield incorrect results. This study aimed to comprehensively analyze independent predictors of postoperative upstaging of intraprostatic cancer. METHODS: We conducted a retrospective analysis of data from intraprostatic cancer patients who underwent radical surgery between March 2019 and December 2022. Intraprostatic cancer was defined as a lesion confined to the prostate, excluding cases where multiparameter magnetic resonance imaging (mpMRI) showed the lesion in contact with the prostatic capsule. We assessed independent predictors of extraprostatic extension (EPE) and analyzed their association with positive surgical margin (PSM) status. In addition, based on the distance of the lesion from the capsule on mpMRI, we divided the patients into non‐transition zone and transition zone groups for further analysis. RESULTS: A total of 500 patients were included in our study. Logistic regression analysis revealed that biopsy Gleason grade group (GG) (odds ratio, OR: 1.370, 95% confidence interval, CI: 1.093–1.718) and perineural invasion (PNI) (OR: 2.746, 95% CI: 1.420–5.309) were predictive factors for postoperative EPE. Both biopsy GG and PNI were associated with lateral (GG: OR: 1.270, 95% CI: 1.074–1.501; PNI: OR: 2.733, 95% CI: 1.521–4.911) and basal (GG: OR: 1.491, 95% CI: 1.194–1.862; PNI: OR: 3.730, 95% CI: 1.929–7.214) PSM but not with apex PSM (GG: OR: 1.176, 95% CI: 0.989–1.399; PNI: OR: 1.204, 95% CI: 0.609–2.381) after RP. Finally, PNI was an independent predictor of EPE in the transition zone (OR: 11.235, 95% CI: 2.779–45.428) but not in the non‐transition zone (OR: 1.942, 95% CI: 0.920–4.098). CONCLUSION: PNI and higher GG may indicate upstaging of tumors in patients with intraprostatic carcinoma. These two factors are associated with PSM in locations other than the apex of the prostate. Importantly, cancer in the transition zone of the prostate is more likely to spread externally through nerve invasion than cancer in the non‐transition zone.