Age Does Not Independently Predict Biochemical Recurrence in Prostate Cancer Following Radical Prostatectomy: A Comparative Analysis of 4223 pT2N0R0 Patients

ABSTRACT Background Whether younger age independently predicts biochemical recurrence (BCR) after radical prostatectomy (RP) remains controversial because previous studies have included heterogeneous pathological stages and treatment populations. We aimed to determine whether age independently predicts BCR following RP in patients with organ‐confined, node‐negative, margin‐negative (pT2N0R0) prostate cancer. Methods We performed a retrospective multicenter cohort study of 4223 patients with pT2N0R0 prostate cancer treated with RP. Patients were stratified into ≤ 55 years ( n = 875; including 223 aged < 50 years) and > 55 years ( n = 3348). BCR was defined as a confirmed prostate‐specific antigen level ≥ 0.2 ng/mL. Kaplan–Meier analyses, multivariable Cox regression, restricted cubic spline modeling, subgroup analyses, and sensitivity analyses were performed. Results Younger patients had lower PSA levels, lower Grade Group, and lower crude BCR rates than older patients (3.8% vs. 5.9%; p = 0.018). However, younger age was not independently associated with BCR after adjustment for clinicopathological variables (hazard ratio 0.52, 95% confidence interval 0.26–1.04; p = 0.075). Higher PSA and Grade Group 3–5 independently predicted recurrence (all p < 0.05). Age analyzed continuously, alternative age thresholds, restricted cubic spline modeling, and subgroup analyses consistently demonstrated no significant association between age and BCR. Limitations include the retrospective design, relatively short follow‐up, and use of BCR as a surrogate endpoint. Conclusions Among men with pT2N0R0 prostate cancer treated with RP, age was not a statistically significant independent predictor of BCR, although a clinically meaningful effect cannot be excluded. Postoperative risk stratification should rely on established pathological factors rather than age alone.