Diagnostic yield and early outcomes of radical prostatectomy without prior histopathologic diagnosis: a single-arm systematic review and meta-analysis.
Alec Anceno, Fernando Loyola-Nieto, Raymundo A Munoz et al.
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In 30 seconds
This single-arm systematic review and random-effects meta-analysis assessed radical prostatectomy without prior histopathologic confirmation in adult men with high clinical suspicion of clinically significant prostate cancer based on imaging and elevated PSA or PSA density. Across 11 studies comprising 648 patients, clinically significant cancer was found in 94.2% (95% CI, 88.4-97.2), while benign pathology occurred in 0.3%. The pooled positive surgical margin rate was 25.4%. Functional outcomes appeared favorable in descriptive reports, but heterogeneous and incomplete reporting prevented quantitative synthesis. Overall risk of bias was serious, largely because of verification bias.
Key findings
- Clinically significant prostate cancer was identified in 94.2% of patients (95% CI, 88.4-97.2); benign pathology occurred in 0.3%.
- The pooled overtreatment rate was 5.7%, and positive surgical margins occurred in 25.4% of cases.
- Diagnostic yield was higher in biopsy-naïve cohorts than in cohorts including patients with a previous negative biopsy (95% vs. 80%; p = 0.005).
- Early urinary continence and erectile function recovery appeared favorable, but outcomes were reported descriptively and could not be quantitatively synthesized.
Why it matters
The findings suggest that imaging and clinical risk assessment can identify a group in whom prostatectomy without prior biopsy often yields clinically significant cancer, with few benign surgical specimens. However, the positive margin rate and serious risk of bias temper confidence in the apparent diagnostic yield. The evidence highlights the need to weigh the potential to avoid biopsy against uncertainty about oncological outcomes.
What to keep in mind
The evidence was single-arm, overall risk of bias was serious because of verification bias, and functional outcomes were heterogeneously and incompletely reported. The absence of a comparator limits interpretation of the positive margin rate.