Oncological Outcomes of Partial vs. Radical Prostatectomy for Localized Prostate Cancer: A Cohort Analysis with Ultrasound Insights

Partial prostatectomy (PP) is emerging as a potential treatment option for localized prostate cancer, offering functional preservation while targeting the dominant lesion believed to drive metastatic progression. However, the multifocal nature of prostate cancer raises concerns about its oncologic safety. This study analyzed data from 64 men who underwent radical prostatectomy between 2014 and 2023 to model PP outcomes and identify factors predicting overlooked cancer foci. Patients met strict criteria, including PSA ≤10 ng/mL, clinical stage ≤T2b, ISUP Grade Group ≤2, and a unilateral dominant lesion on multiparametric MRI (mpMRI) with positive biopsy confirmation. The analysis revealed that PP would have left residual cancer in 25% of cases, with upgrading and upstaging rates of 40% and 46%, respectively. Key predictive factors for missed cancer included cribriform architecture, >45% positive biopsy cores, mpMRI lesion length ≤14 mm, and prostate volume ≤36 cc (AUC=0.86). While mpMRI accurately identified the dominant lesion in 89% of cases, it underestimated tumor size in 70%, with an average size discrepancy of 4.5 mm between radiological and pathological measurements. Most missed cancers were found in the contralateral peripheral zone and prostate apex. These findings highlight the limitations of mpMRI and the critical need for precise safety margins in PP. Despite its appeal as an organ-sparing treatment, PP requires careful patient selection and thorough preoperative evaluation to minimize the risk of leaving residual disease. Future advancements in imaging and biopsy techniques may further refine this approach and enhance its oncological safety.