Time to biochemical recurrence is a strong and independent predictor of css and os in high-risk prostate cancer

Introduction & Objectives: Even though more than half of the patients with highrisk prostate cancer develop biochemical recurrence (BCR) after surgery, the outcome of those who fail is not invariably poor. This study aimed to assess the value of time to BCR as a predictor of cancer-specific survival (CSS) and overall survival (OS) in high-risk PCa patients, treated with radical prostatectomy (RP). Materials & Methods: The study included 1584 patients with pre-operative high risk prostate cancer (PSA>20 ng/ml or cT3-4 or biopsy Gleason 8-10) treated with RP and pelvic LND at 7 tertiary referral centers between 1987 and 2009. Adjuvant and salvage radiotherapy (RT) and hormonal treatment (HT) were administered according to institutional protocols. BCR was defined as PSA>0.2 ng/ml on two subsequent measurements. Results: Mean age at surgery was 65.4 yrs(median 66 yrs; range 41-89). Mean preop PSA was 33.5 ng/ml (median 22.8 ng/ml; range 1-1710 ng/ml). Final Gleason sum was 2-6, 7 and 8-10 in 32.3, 37.7 and 30.0%, respectively. Pathological stage was T2, T3a and >T3a in 23.5, 33.0 and 43.5%, respectively. 24.2% had lymph node invasion and 47.5% had positive surgical margins. Adjuvant RT and HT were administered in 22.1 and 46.4%, respectively. At a mean follow up of 67.1 months (median 62 months; range 1-206), BCR occurred in 33%. CSS was significantly worse in patients with BCR occurring within 2 years from surgery (n=278, 17.7%), compared to those with BCR occurring beyond 2 years (n=239, 15.3%) (10- year CSS 73.2% vs 85.3%, p=0.0008). When the analysis was repeated for the subgroup of 406 patients who did not receive any (neo-) adjuvant treatment, results were even more pronounced with 10-year CSS of 77.2% for the group of patients with BCR ≤2 yrs versus 100% for the other groups (p<0.0001). OS of patients with BCR >2 yrs was identical compared to patients who never experienced BCR in follow-up (10-year OS 75.9% vs 81.4%, p=0.83), while OS of patients with BCR ≤2 yrs from surgery was significantly worse (10-year OS 58.3% vs. 81.4%, p<0.0001). BCR ≤2 yrs (p