A Contemporary Series on Retropubic Radical Prostatectomy and an Analysis of Factors Influencing Biochemical Recurrence-Free Survival

This study investigates outcomes and identifies factors influencing biochemical recurrence and biochemical recurrence-free survival (BRFS) rates in patients undergoing retropubic radical prostatectomy (RRP) at a tertiary university hospital over 10 years. Data of patients who underwent RRP between 2012 and 2022 were analyzed retrospectively. Variables included demographic information, preoperative prostate-specific antigen (PSA) levels, prostate volume, PSA density, operative details, histopathological findings, and postoperative follow-up data. Patients without at least three years of regular follow-up were excluded from the study. The Cox regression analyses were performed to determine the independent risk factors for BRFS. Survival analysis was performed using Kaplan-Meier and the log‐rank test. The final analysis included 115 patients. The median follow-up duration was 77.2 months (range: 36.3–153.6), and the median BRFS was 47.3 months (range: 0–153.6). The 3-year BRFS rate was 61.8%. Positive surgical margins were identified as a significant predictor of BRFS (HR: 2.388, p=0.004), while higher PSA density and the ISUP grade groups also showed associations with recurrence risk (p= 0.033 and 0.048, respectively). Survival analyses confirmed shorter BRFS in patients with positive surgical margins (p=0.000). This study highlights the effectiveness of RRP in the surgical management of localized PCA. Surgical margin status emerged as the primary predictor of BRFS. PSA density may be a promising parameter in predicting biochemical recurrence, but further studies are needed.