Predictive factors for biochemical recurrence after radical prostatectomy in ISUP Grade Group 1 prostate cancer: a retrospective cohort with long-term follow-up

INTRODUCTION: The clinical relevance of biochemical recurrence (BCR) after radical prostatectomy (RP) in ISUP Grade Group 1 prostate cancer is unclear. We evaluated the incidence of BCR, its pathological predictors, and long-term oncologic outcomes in this population. MATERIALS AND METHODS: Retrospective observational study of consecutive patients who underwent RP between 1999 and 2012 with ISUP GG 1 adenocarcinoma in the specimen. BCR was defined as PSA ≥ 0.2 ng/mL in two consecutive measurements after postoperative nadir. BCR-free survival and overall survival were estimated using Kaplan-Meier analysis, and predictors of BCR were identified using Cox regression. Salvage treatments, events of radiologic progression, and mortality were described. RESULTS: A total of 208 patients were included. The median follow-up was 12.1 years. BCR was observed in 45 (21.6%), with a median time to BCR of 5.2 years (IQR 2.3-7.5). Five-year BCR-free survival was 92%, 81% at 10 years, and 78% at 15 years. Positive surgical margins were the only independent predictor of BCR (HR 3.27; 95% CI 1.64-6.53; p < 0.001). Eleven patients with BCR (24.4%) received salvage radiotherapy. Only 3 patients developed radiologic progression (1.4%); 42 deaths (20.2%) were recorded; none of them were cancer-specific deaths. CONCLUSIONS: In ISUP grade group 1 prostate cancer treated with RP, BCR is relatively common but rarely associated with radiologic progression; no cancer-specific deaths were observed during long-term follow-up. Positive margins were associated with a higher risk of BCR.