Postoperative biochemical recurrence of pathologically localized high-grade prostate cancer in adjuvant treatment-naïve patients

Purpose: To evaluate biochemical recurrence (BCR) risk in men with localized prostate cancer (PC) of pathological Gleason score (pGS) 8–10. Although such patients have low BCR-free survival (BCRFS) following radical prostatectomy (RP), they are not recommended for adjuvant radiation therapy (ART) as per current guidelines. Methods: Among an adjuvant treatment-naïve cohort between 1995 and 2015, 1272 men were identified and categorized into group 1 [pGS7 (3 + 4) and pT3; n = 654], group 2 [pGS7 (4 + 3) and pT3; n = 408], and group 3 (pGS 8–10 and pT2; n = 210). The BCR risk of group 3 was compared with that of groups 1 and 2 who are the candidates for ART. Results: At a median follow-up of 60 months (interquartile range: 39–86), 432 men experienced BCR. BCRFS was lower in group 3 than in groups 1 and 2 (p < 0.001 and p = 0.021, respectively). In multivariate analysis, this association persisted and surgical margin (SM) was found to be a significant BCR predictor. Although statistically not significant, BCRFS was lower in group 3 with positive SM (PSM) than in group 2 with PSM (p = 0.101). BCRFS was significantly worse in group 3 with negative SM (NSM) than in group 1 with PSM (p = 0.038), while it was better in group 2 with PSM (p = 0.297). Conclusion: Localized high-grade PC with PSM showed lower BCRFS and that with NSM showed better BCRFS without statistical significance than locally advanced GS 7 PC with PSM that are eligible for ART.