Time to Prostate‐Specific Antigen Failure as a Unique Prognosticator of Overall Survival in Biochemically Recurrent Prostate Cancer Patients Undergoing Radical Prostatectomy

<b>Background:</b> In biochemically recurrent prostate cancer (BRPC), no definitive independent prognostic factors were reported. This study aimed to identify the factors impacting overall survival (OS) in patients with BRPC after radical prostatectomy (RP). <b>Methods:</b> Among 610 consecutive patients who underwent RP between January 2000 and December 2019, with follow-up through December 2024, 152 (25%) patients who developed BRPC were analyzed. The primary endpoint was to identify an independent prognosticator of OS, while the secondary endpoint was to investigate clinical and tumor characteristics in BRPC patients. <b>Results:</b> The median age of the cohort was 67 years. Of the BRPC patients, 37 (24.4%) were managed with observation alone, 80 (52.6%) underwent external beam radiation therapy with or followed by androgen deprivation therapy (ADT), and 35 (23.0%) received ADT alone. During follow-up, two cases of local recurrence and nine cases of distant metastases were observed, with seven patients (1.2%) progressing to castration-resistant prostate cancer. Over a median follow-up of 118 months, 21 all-cause and 5 cancer-specific deaths were recorded. Multivariable analysis identified time to biochemical recurrence (TTBR) as the sole independent significant prognostic factor for OS (hazard ratio: 0.956, 95% confidence interval: 0.916-0.997, <i>p</i>=0.036). Kaplan-Meier survival curves, using a TTBR cutoff of 12 months, revealed significant differences in OS between the shorter and longer TTBR cohorts. <b>Conclusions:</b> This long-term retrospective study demonstrates that TTBR may serve as a unique independent prognostic factor for OS in BRPC patients. A TTBR of ≤ 12 months was significantly associated with worse OS, irrespective of clinicopathological risk features.