Predictors of early, intermediate and late biochemical recurrence after minimally invasive radical prostatectomy in a single-center cohort with a mean follow-up of 8 years

Abstract

ObjectiveTo determine the predictors of early, intermediate and late biochemical recurrence (BR) following minimally invasive radical prostatectomy in patients with localized prostate cancer (PC). Material and methodsWe included 6195 patients with cT1-3N0M0 prostate cancer treated using radical laparoscopic prostatectomy (RLP) and radical robot-assisted prostatectomy at our institution between 2000 and 2016. None of the patients underwent adjuvant therapy. BR is defined as PSA levels ≥0.2ng/dL. The time to BR is divided into terciles to identify the variables associated with early (<12 months), intermediate (12–36 months) and late (>36 months) recurrence. We employed logistic regression models to determine the risk factors associated with each interval. ResultsWe identified 1148 (18.3%) patients with BR. The median time to BR was 24 months (IQR, 0.98–53.18). The multivariate analysis showed that preoperative PSA levels, lymph node invasion, positive margins and RLP are associated with early recurrence (p≤0.029 for all). Laparoscopic surgery was the only predictor of intermediate recurrence (p=0.001). The predictors of late recurrence included a pathological Gleason score ≥7, stage ≥pT3, positive margins and RLP (p≤0.02 for all). ConclusionsThe patients with high-risk prostate cancer can develop late recurrence and require long-term follow-up. Identifying patients with higher PSA levels and lymph node invasion has an important predictive role in the first year after surgery. The association between RLP and BR warrants further assessment.