Is PSA Still the Best Predictor for Biochemical Recurrence after Radical Prostatectomy in High-Risk Prostate Cancer?

Area of Science:

• Urology
• Oncology
• Medical research

Background:

• High-risk prostate cancer (PCa) presents heterogeneous oncological outcomes.
• Radical prostatectomy (RP) is a common treatment for high-risk PCa.
• Predicting biochemical recurrence (BCR) after RP is crucial for patient management.

Purpose of the Study:

• To evaluate the impact of D'Amico criteria subgroups on BCR after RP in high-risk PCa patients.
• To analyze the predictive value of specific D'Amico criteria for oncological outcomes.
• To identify risk factors associated with BCR following RP.

Main Methods:

• Retrospective analysis of high-risk non-metastatic PCa patients who underwent RP (2006-2020).
• Patients were stratified into four groups based on D'Amico criteria: ISUP grade 4-5, clinical stage T2c, tPSA ≥ 20 ng/ml, and locally advanced disease.
• Kaplan-Meier and Log Rank tests were used for survival analyses.

Main Results:

• Biochemical recurrence (BCR) rates differed significantly among the D'Amico criteria groups (P=0.003).
• Group 4 (locally advanced disease) had the highest BCR rate (70.6%), while Group 2 (T2c) had the lowest (13%).
• Elevated tPSA levels (Group 3) were associated with a high BCR rate (40.8%), and ISUP grade 4-5 (Group 1) showed a 30.8% BCR rate.

Conclusions:

• Despite advancements in imaging, elevated total prostate-specific antigen (tPSA) levels remain a critical predictor of BCR-free survival in high-risk prostate cancer patients.
• D'Amico criteria effectively stratify risk for BCR after RP, with locally advanced disease and high tPSA being significant indicators of recurrence.
• Tailored treatment strategies based on these risk factors are essential for improving outcomes in high-risk PCa.