The prognosis of prostate cancers exhibiting extraprostatic extension [other than bladder or seminal vesicle invasion (EPE)] and/or microscopic bladder neck invasion (mBNI) is variable, and further risk stratification is required. We herein assessed radical prostatectomy findings and long-term oncologic outcomes in consecutive 957 patients with pT3a disease. The patient cohort was divided into 4 groups, focal EPE (F-EPE) only (n=177; 18.5%), nonfocal/established (E-EPE) only (n=634; 66.2%), mBNI only (n=51; 5.3%). The rate of positive surgical margin and estimated volume of tumor were significantly higher in patients with both EPE and mBNI than in those with either. In addition, compared with F-EPE or mBNI only, E-EPE only was significantly associated with higher Grade Group, lymph node metastasis, and larger tumor volume. Kaplan-Meier analysis revealed a comparable prognosis after prostatectomy between those showing F-EPE only versus mBNI only (P=0.986), and these 2 cohorts were combined for further analysis. Then, patients showing E-EPE only had a significantly higher or lower risk of progression compared with those showing F-EPE or mBNI only (P<0.001) or both EPE and mBNI (P<0.001), respectively. These significant differences in progression-free survival were also seen in subgroups, including those with or without undergoing adjuvant therapy before recurrence and those showing no lymph node metastasis. In multivariate analysis, F-EPE or mBNI only (hazard ratio=0.524, P=0.003) or both EPE and mBNI (hazard ratio=1.465, P=0.039) (vs. E-EPE only) showed significance for progression. Based on these findings, we propose a novel pT3a subclassification, pT3a1 (F-EPE or mBNI alone), pT3a2 (E-EPE alone), and pT3a3 (both EPE and mBNI).

表现出前列腺外扩散[膀胱或精囊侵犯（EPE）除外]和/或显微镜下膀胱颈侵犯（mBNI）的前列腺癌的预后是可变的，需要进一步的风险分层。我们在此评估了连续 957 名 pT3a 疾病患者的根治性前列腺切除术结果和长期肿瘤学结果。患者队列被分为 4 组，仅局灶性 EPE (F-EPE)（n=177；18.5%）、仅非局灶性/既定 (E-EPE)（n=634；66.2%）、仅 mBNI（n=51） ；5.3%）。EPE 和 mBNI 患者的手术切缘阳性率和估计肿瘤体积显着高于其中任何一种患者。此外，与仅F-EPE或mBNI相比，仅E-EPE与较高级别组、淋巴结转移和较大肿瘤体积显着相关。Kaplan-Meier 分析显示，仅显示 F-EPE 的患者与仅显示 mBNI 的患者在前列腺切除术后的预后相当（P = 0.986），并且将这 2 个队列合并进行进一步分析。然后，与仅显示 F-EPE 或 mBNI ( P <0.001) 或同时显示 EPE 和 mBNI ( P <0.001)的患者相比，仅显示 E-EPE 的患者的进展风险显着较高或较低。这些无进展生存期的显着差异也出现在亚组中，包括复发前接受或未接受辅助治疗的亚组以及未出现淋巴结转移的亚组。在多变量分析中，仅 F-EPE 或 mBNI（风险比 = 0.524，P = 0.003）或 EPE 和 mBNI（风险比 = 1.465，P = 0.039）（与仅 E-EPE 相比）显示出对进展的显着性。基于这些发现，我们提出了一种新的 pT3a 亚分类：pT3a1（单独的 F-EPE 或 mBNI）、pT3a2（单独的 E-EPE）和 pT3a3（EPE 和 mBNI）。