Impact of preoperative risk on metastatic progression and cancer‐specific mortality in patients with adverse pathology at radical prostatectomy

Objective To evaluate the impact of preoperative risk category on metastatic disease and prostate cancer‐specific mortality ( CSM ) in patients with prostate cancer ( PC a) with adverse pathology at radical prostatectomy ( RP ). Patients and Methods The records of 6 943 patients who underwent RP at a European tertiary centre were analysed. Biochemical recurrence ( BCR ), metastatic disease and CSM were assessed for patients with adverse pathology at RP , and stratified according to preoperative low‐ vs intermediate‐/high‐risk PC a groups. Kaplan–Meier, cumulative incidence, Cox regression and competing risk regression analyses were performed. Results In patients with extracapsular extension, the metastatic disease rate was 1.6% vs 8% ( P < 0.001) and the CSM rate was 2% vs 5% ( P = 0.041) for low vs intermediate‐/high‐risk patients, respectively, at 10 years. In patients with pathological Gleason score ≥3+4, the metastatic disease rate was 3.0% vs 12% ( P < 0.001) and the CSM rate was 3% vs 8%, respectively ( P < 0.001). In patients with positive surgical margins ( PSM s), the metastatic disease rate was 2.9% vs 15% ( P < 0.001) and the CSM rate was 4% vs 10%, respectively ( P = 0.0001). Low‐risk status was a predictive factor for metastatic disease in patients with pathological Gleason score ≥3+4 (hazard ratio [ HR ] 0.51), pathological Gleason score ≥4+3 ( HR 0.41) and PSM s ( HR 0.46) and was a predictive factor for CSM risk in patients with pathological Gleason score ≥3+4 ( HR 0.62). Conclusions Patients with low‐risk PC a were at significantly lower risk of metastatic disease and CSM than their intermediate‐/high‐risk counterparts, when adverse pathological features were identified at RP . This should be emphasized in the decision‐making process after RP .