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Incidence, Risk Factors, and Clinical Characteristics of Late Biochemical Recurrence Following Robot-Assisted Radical
Takato Nishino1, Masaki Shimbo1, Masayuki Sano1
1Department of Urology, St. Luke's International Hospital, Tokyo, Japan.
Summary
Late biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) is not uncommon. Patients with lymphovascular or seminal vesicle invasion face higher risks, necessitating continued monitoring post-surgery.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Robot-assisted radical prostatectomy (RARP) is a common treatment for prostate cancer.
- Understanding recurrence patterns after RARP is crucial for long-term patient management.
- Late biochemical recurrence (BCR), defined as occurring 5 or more years post-surgery, requires specific investigation.
Purpose of the Study:
- To investigate the clinical characteristics of late BCR after RARP.
- To determine the prognostic significance of late BCR.
- To identify predictors and long-term outcomes associated with late BCR.
Main Methods:
- Retrospective review of 1106 patients undergoing RARP (2011-2023).
- Analysis of 552 patients with ≥5 years follow-up, stratified into no recurrence, early recurrence (<5 years), and late recurrence (≥5 years).
- Cox proportional hazards models and Kaplan-Meier analyses were used to assess predictors and outcomes.
Main Results:
- 32 patients experienced late BCR (≥5 years post-RARP).
- Lymphovascular invasion and seminal vesicle invasion were significant risk factors for late BCR.
- No patients with late BCR progressed to castration-resistant prostate cancer, unlike 11% with early recurrence.
Conclusions:
- Late BCR after RARP is a recognized clinical event, particularly in patients with specific pathological findings.
- Patients without lymphovascular or seminal vesicle invasion may benefit from de-escalated surveillance.
- Close monitoring is recommended for patients with risk factors to enable timely intervention.
