Outcome of radical prostatectomy in high-risk prostate cancer and predictors of biochemical recurrence

Background: Radical prostatectomy (RP) is an established treatment option for (d’Amico) high-risk prostate cancer (HRPC) as part of multimodal therapy. We aimed to find out the prostate cancer-specific survival (PCSS) and biochemical recurrence-free survival (BCRFS) after RP in HRPC patients. Method and Materials: We analysed retrospectively the pre-operative staging, histopathology, follow-up data and subsequent additional treatment of all patients who had RP from 2007 to 2017. The PCSS and BCRFS of HRPC were analysed using the Kaplan–Meier survival analysis curve. Results: A total of 497 patients had RP in the study period of which 217 were HRPC patients. Positive surgical margin, extracapsular extension, seminal vesicle involvement, lymph node involvement and International society of uro-pathology Gleason’s grade group (ISUP GGG) ⩾3 cancer were 34.1%, 52.9%, 15.2%, 5.5% and 47.5%, respectively. Median follow-up was 82.5 months (13–178 months). Fifteen patients (6.9%) had upfront adjuvant radiotherapy. Seventy-eight patients (35.9%) had biochemical recurrence (BCR) at median follow-up of 24 months (3–120 months). Salvage radiotherapy and hormone-only therapy were offered to 57 (73.0%) and 4 (5.1%) patients, respectively, whereas 17 patients (21.7%) were under observation. A total of 76 patients (35.0%) required multimodal therapy. At 10 years, PCSS and BCRFS were 92% and 55%, respectively. Both biopsy GGG ( p = 0.003) and post-operative GGG ( p = 0.002) as well as seminal vesical involvement ( p < 0.001) were significantly associated with BCR. Conclusion: RP in HRPC offers favourable long-term oncological outcome with acceptable peri-operative and delayed complications. Patients must be counselled about the requirement of multimodal therapy. Gleason’s score and seminal vesical (SV) involvement are strong predictors of BCR.