Long-term oncologic outcomes of patients with grade group 1 prostate cancer and pT3a disease on final pathology

BACKGROUND: Grade Group 1 (GG1) prostate cancer is biologically indolent and typically managed with active surveillance (AS), yet pT3a pathology is occasionally identified at radical prostatectomy (RP). Its prognostic significance in GG1 disease remains incompletely defined. METHODS: Retrospective cohort of 40 patients with GG1 and pT3a disease on RP (2000-2022), confirmed on central pathologic re-review. RESULTS: Four patients developed biochemical recurrence (BCR); the cumulative incidence of BCR was 3.2% at 5 years and 10.3% at 15 years. No patient developed metastatic disease or prostate cancer-specific mortality. CONCLUSIONS: GG1 pT3a prostate cancer demonstrates excellent long-term outcomes. Adverse histologic features, not pathological stage alone, drive clinically meaningful risk. Late, stable PSA detectability alone does not signify meaningful recurrence.