Independent Predictors Of BCR-free Survival Research Articles

MRI-derived tumor volume as a predictor of biochemical recurrence and adverse pathology in patients after radical prostatectomy: a propensity score matching study.

To investigate the predictive value of MRI-derived tumor volume (TV) of biochemical recurrence (BCR) and adverse pathology (AP) in patients following radical prostatectomy (RP). The data of 565 patients receiving RP in a single institution between 2010 and 2021 were retrospectively analyzed. All suspicious tumor foci were delineated manually using ITK-SNAP software as the regions of interest (ROIs). The sum of the TV of all lesions was calculated automatically based on the voxel in the ROIs to acquire the final TV parameter. TV was categorized as low-volume (≤ 6.5cm3) and high-volume (> 6.5cm3) based on the cut-off value. Univariate and multivariate Cox and logistic regression analyses were performed to identify independent predictors of BCR and AP. The Kaplan-Meier with the log-rank test was conducted to compare the BCR-free survival (BFS) between the low and high-volume groups. All the included patients were divided into the low-volume group (n = 337) and the high-volume group (n = 228). The TV was an independent predictor of BFS in the multivariate Cox regression analysis (Hazard Ratio (HR) [95% CI]: 1.550 [1.066-2.256], P = 0.022). The Kaplan-Meier analysis demonstrated that low volume was associated with a better BFS than high volume before propensityscore matching (PSM) (P < 0.001). One hundred and fifty-eight pairs were obtained by 1:1 PSM to balance the baseline parameters between the two groups. After the PSM, low-volume remained to be associated with a better BFS than high-volume (P = 0.006). TV as a categorical variable was an independent factor of AP in multivariate logistic regression analysis (Odd ratio (OR) [95% CI]: 1.821 [1.064-3.115], P = 0.029). After balancing the potential factors influencing AP by 1:1 PSM, 162 new pairs were identified. The high-volume group had a higher AP rate than the low-volume group after PSM (75.9 vs. 64.8%, P = 0.029). We adopted a novel approach to acquiring the TV on preoperative MRI. TV was significantly associated with BFS and AP of patients undergoing RP, which was further illustrated by PSM analysis. MRI-derived TV may serve as a predictive marker for assessing BFS and AP in further studies, which will facilitate clinical decision-making and patient counseling.

LBA03-04 MRI-DERIVED TUMOR VOLUME AS A PREDICTOR OF BIOCHEMICAL RECURRENCE AND ADVERSE PATHOLOGY IN PATIENTS AFTER RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHING STUDY

You have accessJournal of UrologyCME1 Apr 2023LBA03-04 MRI-DERIVED TUMOR VOLUME AS A PREDICTOR OF BIOCHEMICAL RECURRENCE AND ADVERSE PATHOLOGY IN PATIENTS AFTER RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHING STUDY Xuehua Zhu, Zenan Liu, Jide He, Ziang Li, Wei He, and Jian Lu Xuehua ZhuXuehua Zhu More articles by this author , Zenan LiuZenan Liu More articles by this author , Jide HeJide He More articles by this author , Ziang LiZiang Li More articles by this author , Wei HeWei He More articles by this author , and Jian LuJian Lu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003426.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate the predictive value of MRI-derived tumor volume (TV) of biochemical recurrence (BCR) and adverse pathology (AP) in patients following radical prostatectomy (RP). METHODS: The data of 565 patients with prostate cancer (PCa) receiving RP in a single institution between 2010 to 2021 were retrospectively analyzed. All suspicious tumor foci were delineated manually using ITK-SNAP software as the region of interest (ROI). The sum of the TV of all lesions was calculated automatically based on the voxel in the ROIs to acquire the final TV parameter. TV was categorized as low-volume (≤6.5 cm3) and high-volume (>6.5 cm3) based on the cut-off value. Univariate and multivariate Cox and logistic regression analyses were performed to identify independent predictors of BCR and AP. The Kaplan-Meier method with the log-rank test was conducted to compare the BCR-free survival (BFS) between the low and high-volume groups. RESULTS: Results: All the included patients were divided into the low-volume group (n=337) and the high-volume group (n=228). The TV was an independent predictor of BFS in the multivariate Cox regression analysis (Hazard Ratio (HR) [95% CI]: 1.550 [1.066-2.256], p=0.022 ). The Kaplan-Meier analysis demonstrated that low volume was associated with a better BFS than high-volume before PSM (p=0.00). One hundred and fifty-eight pairs were obtained by 1:1 PSM to balance the baseline parameters between the two groups. After the PSM, low-volume remained to be associated with a better BFS than high-volume (p=0.006). In addition, patients with AP had a larger median TV than patients without AP (6.10 ml vs. 2.67 ml, p=0.00). TV as a categorial variable was an independent factor of AP in multivariate logistic regression analysis (Odd ratio (OR) [95% CI]: 1.821 [1.064-3.115], p=0.029). After balancing the potential factors influencing AP by 1:1 PSM, 162 new pairs were identified. The high-volume group had a higher AP rate than the low-volume group after PSM (75.9% vs. 64.8%, p=0.029). CONCLUSIONS: Conclusions: We adopted a novel approach to acquiring the TV parameter on preoperative MRI. A threshold value(6.5cm3) of the TV was identified from the ROIs on the MRI. TV was significantly associated with BFS and AP of patients undergoing RP, which was further illustrated by PSM analysis. MRI-derived TV may serve as a predictive marker for assessing BFS and AP in further studies, which will facilitate clinical decision-making and patient counseling. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1193 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xuehua Zhu More articles by this author Zenan Liu More articles by this author Jide He More articles by this author Ziang Li More articles by this author Wei He More articles by this author Jian Lu More articles by this author Expand All Advertisement PDF downloadLoading ...

Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center

BackgroundIdentifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP).MethodsFrom 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR.ResultsIn pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates.ConclusionsPSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.

Race, tumor location, and disease progression among low-risk prostate cancer patients.

BackgroundThe relationship between race, prostate tumor location, and BCR‐free survival is inconclusive. This study examined the independent and joint roles of patient race and tumor location on biochemical recurrence‐free (BCR) survival.MethodsA retrospective cohort study was conducted among men with newly diagnosed, biopsy‐confirmed, NCCN‐defined low risk CaP who underwent radical prostatectomy (RP) at the Walter Reed National Military Medical Center from 1996 to 2008. BCR‐free survival was modeled using Kaplan‐Meier estimation curves and multivariable Cox proportional hazards (PH) analyses.ResultsThere were 539 eligible patients with low‐risk CaP (25% African American, AA; 75% Caucasian American, CA). Median age at CaP diagnosis and post‐RP follow‐up time was 59.2 and 8.1 years, respectively. Kaplan‐Meier analyses showed no significant association between race (P = .52) or predominant tumor location (P = .98) on BCR‐free survival. In Cox PH multivariable analysis, neither race (HR = 1.18; 95% CI = 0.68‐2.02; P = .56) nor predominant tumor location (HR = 1.13; 95% CI = 0.59‐2.15; P = .71) was an independent predictor of BCR‐free survival.ConclusionsNeither race nor predominant tumor location was associated with adverse oncologic outcome.

Outcomes of men aged ≤50 years treated with radical prostatectomy: a retrospective analysis.

Previous studies investigating prostate cancer (PCa) features in younger men have reported conflicting findings. This study aimed to investigate pathologic outcomes and biochemical recurrence (BCR) status in younger men who underwent radical prostatectomy (RP) for PCa. Records of 2057 patients who underwent RP at Seoul National University Bundang Hospital (Seongnam, Korea) between 2006 and 2015 were reviewed; patients were divided according to age into the younger and older groups (men aged ≤50 and >50 years, respectively). Postoperative BCR status and functional outcomes and clinicopathologic features were compared between both groups. All analyses were repeated after propensity score matching. Younger men were more likely to have low-risk disease (P < 0.001), lower pathologic Gleason score (P < 0.001) and pathologic stages (P < 0.001) than older men. The pathologic Gleason score (P = 0.002) and rates of extracapsular extension (P = 0.004) were lower in younger men after propensity score matching. In multivariate analysis, age at RP was not an independent predictor of BCR-free survival after RP (P = 0.669). Moreover, at 1 year after RP, younger men with preoperative 5-item International Index of Erectile Function score ≥22 (n = 228) showed more favorable results for urinary continence (defined as nonuse of pads daily) (99.4% vs 95%, P = 0.009) and erections sufficient for vaginal intercourse (81.8% vs 55.5%, P = 0.001). Younger men had more favorable clinicopathologic features at RP than their older counterparts. Although age was not an independent predictor of BCR status outcome, younger men had better functional outcomes following RP.

Impact of Body Mass Index on Oncological Outcomes of Prostate Cancer Patients after Radical Prostatectomy

Obesity, often represented by higher body mass index (BMI), is not yet fully understood as a potential risk factor for poor clinical outcomes of prostate cancer (PCa) after radical prostatectomy (RP). This study aimed to evaluate the relationship between BMI and biochemical recurrence (BCR)-free survival in RP patients. This study retrospectively reviewed a total of 2.997 PCa patients who underwent RP between 2006 and 2017. The patients were stratified into three BMI groups according to the WHO recommendations for Asian men: normal weight (<23 kg/m2), overweight (≥23 to <27.5 kg/m2) and obese (≥27.5 kg/m2). Multivariable logistic regression analyses were undertaken to evaluate the factors influencing the BCR rates including BMI. Multivariable Cox regression analyses and Kaplan-Meier analyses were performed to test the association of obesity with BCR-free survival. The final pathologic results showed obese patients had greater positive surgical margin rates (13.9%, p < 0.001), extraprostatic invasion (19.9%, p < 0.001), advanced pathological Gleason score (GS) ≥ 8 (50.8%, p = 0.017), and lymph node invasion (LNI) (14.5%, p = 0.021) than overweight and normal weight patients. According to Kaplan-Meier analyses, obese patients, especially with BMI ≥ 27.5, were more likely to have lower BCR-free-survival. Multivariate Cox analysis revealed that diabetes mellitus, LNI status, pT, pathologic GS, extraprostatic invasion, margin positivity and obesity with BMI ≥ 27.5 kg/m2 were significantly associated with BCR-free survival after RP. Obesity (higher BMI) was significantly associated with BCR after RP. BMI ≥ 27.5 kg/m2 was an independent predictor of BCR-free survival.

Prostate-specific antigen measured 3 months after radical prostatectomy as a new predictor of biochemical recurrence

This study was undertaken to investigate if the prostate-specific antigen (PSA) level measured 3 months after radical prostatectomy (RP) is a predictor of biochemical recurrence (BCR)-free survival. We retrospectively reviewed the clinicopathologic data of 174 patients with a follow-up of at least 3 years after RP for clinically localized prostate cancer. None of the patients received neoadjuvant/adjuvant therapy. Subjects were categorized according to PSA level 3 months after RP (3M-PSA): <0.010 ng/mL (group 1; n = 119) or 0.010-0.100 ng/mL (group 2; n = 55). BCR was defined as two consecutive rises in PSA level ≥0.2 ng/mL. At a median follow-up of 69.5 months (range 36-113 months), 32 (18.4 %) patients experienced BCR. The median time to BCR was 16 months (range 4-98 months) after RP. The 5-year BCR-free survival rate was 92.6 and 57.4 % in groups 1 and 2, respectively. Patients in group 1 had a significantly higher BCR-free survival rate than those in group 2 (log-rank P < 0.001). According to the Cox proportional hazards model, patients with a 3M-PSA level of <0.010 ng/mL were at lower risk for BCR (P < 0.001), along with pathologic Gleason sum 6 (P = 0.028). PSA nadir level after RP was also a risk factor for BCR (log-rank P < 0.001). Area under the receiver operating characteristic curve for 3M-PSA to predict BCR was almost equivalent to that for the PSA nadir level (0.855 vs. 0.849). 3M-PSA is an independent predictor of BCR-free survival. Our findings might be used for a risk-adjusted follow-up protocol.

Aberrant methylation of PCDH10 predicts worse biochemical recurrence-free survival in patients with prostate cancer after radical prostatectomy.

BackgroundProstate cancer is a common malignancy in men, and inevitably some patients experience biochemical recurrence after radical prostatectomy. To date, there are no reliable predictors for prostate cancer recurrence, and novel predictors are urgently needed. PCDH10 (protocadherin-10) is a novel tumor suppressor gene, which is down-regulated by promoter methylation in prostate cancer. The aim of this study was to evaluate the feasibility of using PCDH10 methylation to predict the biochemical recurrence (BCR) of prostate cancer after radical prostatectomy.Material/MethodsFresh tissue samples were obtained from 151 patients with primary prostate cancer, and from 34 patients with benign prostatic hyperplasia (BPH) as control. The methylation status of PCDH10 in prostate cancer tissues and controls were examined using methylation-specific PCR (MSP), and then associated with clinicopathological features and BCR-free survival of patients with prostate cancer.ResultsWe found that PCDH10 methylation was detected in 79 (52.3%) patients with prostate cancer, but no methylation was found in controls (P<0.0001). Moreover, PCDH10 methylation was significantly associated with higher preoperative prostate-specific antigen (PSA) level (P <0.0001), higher Gleason Score (P<0.0001), advanced clinical stage (P=0.0002), lymph node metastasis (P=0.0389), angiolymphatic invasion (P=0.0303), and biochemical recurrence (P=0.0068). Moreover, PCDH10 methylation was associated with poor BCR-free survival (P<0.0001), and may be used as an independent predictor of BCR-free survival (P=0.0046).ConclusionsOur results indicate that PCDH10 methylation in prostate cancer tissue is an independent prognostic biomarker of worse BCR-free survival of patients with prostate cancer after radical prostatectomy.

Association of microRNA-126 expression with clinicopathological features and the risk of biochemical recurrence in prostate cancer patients undergoing radical prostatectomy

ObjectiveNumerous studies have suggested that microRNA-126 (miR-126) is involved in development of various cancer types as well as in malignant proliferation and invasion. However, its role in human prostate cancer (PCa) is still unclear. The aim of this study was to investigate miR-126 expression in PCa and its prognostic value for PCa patients undergoing radical prostatectomy.MethodsA series of 128 cases with PCa were evaluated for the expression levels of miR-126 by quantitative reverse-transcription PCR (qRT-PCR). Kaplan-Meier analysis and Cox proportional hazards regression models were used to investigate the correlation between miR-126 expression and prognosis of PCa patients.ResultsCompared with non-cancerous prostate tissues, the expression level of miR-126 was significantly decreased in PCa tissues (PCa vs. non-cancerous prostate: 1.05 ± 0.63 vs. 2.92 ± 0.98, P < 0.001). Additionally, the loss of miR-126 expression was dramatically associated with aggressive clinical pathological features, including advanced pathological stage (P = 0.001), positive lymph node metastasis (P = 0.006), high preoperative PSA (P = 0.003) and positive angiolymphatic invasion (P = 0.001). Moreover, Kaplan–Meier survival analysis showed that PCa patients with low miR-126 expression have shorter biochemical recurrence (BCR)-free survival than those with high miR-126 expression. Furthermore, multivariate analysis indicated that miR-126 expression was an independent prognostic factor for BCR-free survival after radical prostatectomy.ConclusionThese findings suggest for the first time that the loss of miR-126 expression may play a positive role in the malignant progression of PCa. More importantly, the downregulation of miR-126 may serve as an independent predictor of BCR-free survival in patients with PCa.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1740080792113255.

Clinical significance of NUCB2 mRNA expression in prostate cancer

BackgroundNucleobindin 2 (NUCB2) abnormal expression has been reported in gastric cancer and breast cancer. However, the role of NUCB2 in prostate cancer (PCa) remains unclear. The aim of the present study was to investigate the NUCB2 expression in PCa tissues and adjacent non-cancerous tissues and its potential relevance to clinicopathological variables and prognosis.MethodsNUCB2 mRNA expression was determined by real-time quantitative real time reverse transcriptase polymerase chain reaction in 180 pairs of fresh frozen PCa tissues and corresponding non-cancerous tissues. Kaplan-Meier analysis and Cox proportional hazards regression models were used to investigate the correlation between NUCB2 expression and prognosis of PCa patients.ResultsOur results showed that the expression level of NUCB2 mRNA in PCa tissues was significantly higher than those in non-cancerous tissues. Our results indicated that the high expression of NUCB2 in PCa was associated with lymph node metastasis, preoperative PSA, Gleason score, and angiolymphatic invasion. Kaplan–Meier survival analysis showed that patients with high NUCB2 expression have shorter biochemical recurrence (BCR)-free survival time compared to patients with low NUCB2 expression. Multivariate analysis revealed that NUCB2 expression was an independent predictor of BCR-free survival.ConclusionsNUCB2 might play a positive role in PCa development and could serve as an independent predictor of BCR-free survival.

The Prognostic Value of Pathologic Prostate-specific Antigen Mass Ratio in Patients With Localized Prostate Cancer With Negative Surgical Resection Margins

To investigate potential predictors of biochemical recurrence (BCR) in patients with localized prostate cancer with negative surgical resection margin (SRM). Data from 582 consecutive patients diagnosed with localized prostate cancer with negative SRM who underwent only radical prostatectomy between November 2003 and April 2010 were reviewed. Pathologic prostate-specific antigen (PSA) mass ratio was defined as total circulating PSA protein per surgical prostate volume. Cox regression models tested the association between clinicopathologic variables and BCR-free survival. Mean age at surgery was 64.9 ± 6.9 years and mean PSA was 8.3 ± 4.4 ng/mL. The mean follow-up period was 40.7 ± 7.9 months. Pathologic stage was T2a in 113 of 582 patients (19.3%), T2b in 4 of 582 (0.7%), and T2c in 465 of 582 (79.9%). Surgical Gleason score was≤6 in 215 of 582patients (37.0%), 7 in 342 of 582 (58.8%), and≥8 in 25 of 582 (4.3%). Mean pathologic prostate volume and pathologic PSA mass ratio were 42.4 ± 15.8 mL (14.6-176.0 mL) and 0.48± 0.37 μg/mL (0.03-2.62 μg/mL), respectively. Five-year BCR-free survival rate was 90.9%. PSA, surgical Gleason score, and pathologic PSA mass ratio were significantly associated with BCR-free survival in univariate analysis. In multivariate analysis, surgical Gleason score (P<.001, hazards ratio= 9.804) and pathologic PSA mass ratio (P= .037, hazards ratio= 3.753) were independent predictors of BCR-free survival. In patients with localized prostate cancer and negative SRM after radical prostatectomy, surgical Gleason score and pathologic PSA mass ratio were significant prognostic indicators of BCR-free survival.

Commentary on Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: The positive impact of adjuvant radiotherapy

Recent large, prospective, randomized studies have demonstrated that adjuvant radiotherapy (RT) is a safe and effective procedure for preventing disease recurrence in locally advanced prostate cancer (PCa) patients. However, no study has ever tested the role of adjuvant RT in node-positive patients after radical prostatectomy (RP). We hypothesized that adjuvant RT with early hormone therapy (HT) might improve long-term outcomes of patients with PCa and nodal metastases treated with RP and extended pelvic lymph node dissection (ePLND). This retrospective study included 250 consecutive patients with pathologic lymph node invasion. We assessed factors predicting long-term biochemical recurrence (BCR)-free and cancer-specific survival (CSS) in node-positive PCa patients treated with RP, ePLND, and adjuvant treatments between 1988 and 2002 in a tertiary academic center. All patients received adjuvant treatments according to the treating physician after detailed patient information: 129 patients (51.6%) were treated with a combination of RT and HT, while 121 patients (48.4%) received adjuvant HT alone. BCR-free survival and CSS in patients with node-positive PCa: Mean follow-up was 95.9 months (median: 91.2). BCR-free survival and CSS rates at 5, 8, and 10 years were 72%, 61%, 53%, and 89%, 83%, 80%, respectively. In multivariable Cox regression models, adjuvant RT and the number of positive nodes were independent predictors of BCR-free survival (P = 0.002 and P = 0.003, respectively) as well as of CSS (P = 0.009 and P = 0.01, respectively). Moreover, there was significant gain in predictive accuracy when adjuvant RT was included in multivariable models predicting BCR-free survival and CSS (gain: 3.3% and 3%, respectively; all P < 0.001). Our data showed excellent long-term outcome for node-positive PCa patients treated with radical surgery plus adjuvant treatments. This study is the first to report a significant protective role for adjuvant RT in BCR-free survival and CSS of node-positive patients.

Long-Term Follow-up of Patients with Prostate Cancer and Nodal Metastases Treated by Pelvic Lymphadenectomy and Radical Prostatectomy: The Positive Impact of Adjuvant Radiotherapy

BackgroundRecent large, prospective, randomised studies have demonstrated that adjuvant radiotherapy (RT) is a safe and effective procedure for preventing disease recurrence in locally advanced prostate cancer (PCa) patients. However, no study has ever tested the role of adjuvant RT in node-positive patients after radical prostatectomy (RP). ObjectiveWe hypothesised that adjuvant RT with early hormone therapy (HT) might improve long-term outcomes of patients with PCa and nodal metastases treated with RP and extended pelvic lymph node dissection (ePLND). Design, setting, and participantsThis retrospective study included 250 consecutive patients with pathologic lymph node invasion. We assessed factors predicting long-term biochemical recurrence (BCR)–free and cancer-specific survival (CSS) in node-positive PCa patients treated with RP, ePLND, and adjuvant treatments between 1988 and 2002 in a tertiary academic centre. InterventionAll patients received adjuvant treatments according to the treating physician after detailed patient information: 129 patients (51.6%) were treated with a combination of RT and HT, while 121 patients (48.4%) received adjuvant HT alone. MeasurementsBCR-free survival and CSS in patients with node-positive PCa. Results and limitationsMean follow-up was 95.9 mo (median: 91.2). BCR-free survival and CSS rates at 5, 8, and 10 yr were 72%, 61%, 53% and 89%, 83%, 80%, respectively. In multivariable Cox regression models, adjuvant RT and the number of positive nodes were independent predictors of BCR-free survival (p=0.002 and p=0.003, respectively) as well as of CSS (p=0.009 and p=0.01, respectively). Moreover, there was significant gain in predictive accuracy when adjuvant RT was included in multivariable models predicting BCR-free survival and CSS (gain: 3.3% and 3%, respectively; all p<0.001). ConclusionsOur data showed excellent long-term outcome for node-positive PCa patients treated with radical surgery plus adjuvant treatments. This study is the first to report a significant protective role for adjuvant RT in BCR-free survival and CSS of node-positive patients.