The prostatic inflammation score and risk of biochemical recurrence following radical prostatectomy

Inflammatory processes are thought to contribute to the development and progression of prostate cancer (PCa). This study aimed to evaluate whether a novel Prostatic Inflammation Score (PIS), integrating Irani Grade (G) and Aggressiveness (A), could predict the risk of biochemical recurrence (BCR) following radical prostatectomy (RP).

Patients undergoing biopsy and RP between 2013 and 2023 were included. PIS was assessed on hematoxylin and eosin-stained biopsy cores: PIS 1 (G 0-1/A 0-1), PIS 2 (G 2-3/A 0-1), and PIS 3 (G 0-3/A 2-3). BCR, considered as two consecutive PSA readings of ≥ 0.2 ng/mL, was evaluated through multivariable Cox regression analysis.

Among 679 patients (median follow-up: 36 months), 127 (18.7%) experienced BCR. Over a median follow-up of 36 months, 127 (18.7%) patients experienced BCR. BCR incidence at six years was highest in PIS 1 (30%) vs. PIS 2 (10%) and PIS 3 (9%) (p = 0.002). Compared to PIS 1, hazard ratios (HR) for BCR were 0.44 (95% CI: 0.27-0.74) for PIS 2 and 0.37 (95% CI: 0.15-0.91) for PIS 3. IRANI G scores inversely correlated with BCR risk (HR = 0.44, 95% CI: 0.27-0.74), while IRANI A scores (2-3) showed a nonsignificant trend (HR = 0.41, 95% CI: 0.17-1.02, p = 0.054). Gleason grade and pT stage were significantly associated with BCR, while margin status and pN stage were not.

PIS 1 was found to be associated with BCR after RP. Should these findings be externally validated, PIS could represent a readily available inexpensive tool to predict BCR after RP.