Prediction of adverse pathological features after radical prostatectomy for prostate cancer by clinical indicators and association with biochemical failure

doi:10.3969/j.issn.1006-7795.2026.02.006

Abstract

Abstract: Objective To investigate the incidence of adverse pathological features (APF) after radical prostatectomy (RP) in prostate cancer (PCa) patients, evaluate the predictive value of preoperative clinical indicators for APF, and explore the association between APF and postoperative biochemical failure.Methods Clinical data of PCa patients who underwent RP at Beijing Friendship Hospital, Capital Medical University from July 2016 to July 2024 were retrospectively collected, including general characteristics, imaging and laboratory examinations, biopsy and postoperative pathology，and follow-up data. APF was determined based on pathological findings. Univariate and multivariate Logistic regression analyses were performed to identify independent predictors of APF and to construct a nomogram, while Cox regression analysis was used to identify predictors of biochemical failure. Results A total of 352 patients were included. The incidence of APF after RP was 66.76% (235 cases), including positive surgical margin in 174 cases (49.43%), extraprostatic extension in 102 cases (28.98%), and seminal vesicle invasion in 51 cases (14.49%). Biochemical failure occurred in 39.77% of patients. The APF group had significantly higher rates of biochemical failure，with a shorter time to biochemical recurrence (28.0 months vs not reached，P<0.001). Multivariate analysis revealed that elevated body mass index (BMI), increased prostate-specific antigen density (PSAD) and advanced clinical stage were independent predictors of APF, and Cox regression analysis showed that APF （HR=1.75，95% CI: 1.13-2.72，P=0.012） and higher International Society of Urological Pathology (ISUP) grade（HR=1.50，95%CI: 1.06-2.14，P=0.023） were independent risk factors for biochemical failure. Conclusion APF is closely associated with biochemical failure after RP. Preoperative BMI, PSAD and clinical stage can serve as valuable indicators for predicting APF.

Key words: prostate cancer, radical prostatectomy, adverse pathological features, biochemical recurrence, biochemical persistence, risk factors, prognosis

CLC Number:

Zhao Youquan, Xiong Tianyu, Xie Ping, Niu Yinong. Prediction of adverse pathological features after radical prostatectomy for prostate cancer by clinical indicators and association with biochemical failure[J]. Journal of Capital Medical University, 2026, 47(2): 259-266.

References

［1］Siegel R L, Giaquinto A N, Jemal A. Cancer statistics, 2024［J］. CA Cancer J Clin, 2024, 74(1): 12－49.
［2］Tosoian J J, Yu A, Brisbane W G. Point of view: innovation and progress for screening and management of localized prostate cancer: what an exciting time［J］. J Urol, 2024, 211(2): 317－319.
［3］Bejrananda T, Pliensiri P. Prediction of biochemical recurrence after laparoscopic radical prostatectomy［J］. BMC Urol, 2023, 23(1): 183.
［4］赵峻樑, 赵迪威, 刘洋, 等. 根治性前列腺切除术后不良病理特征患者的放疗选择［J］. 中华泌尿外科杂志, 2022, 43(7): 555－558.
［5］Nasri J, Barthe F, Parekh S, et al. Nomogram predicting adverse pathology outcome on radical prostatectomy in low-risk prostate cancer men［J］. Urology, 2022, 166: 189－195.
［6］Cornford P, Van Den Bergh R C N, Briers E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer-2024 update. Part I: screening, diagnosis, and local treatment with curative intent［J］. Eur Urol, 2024, 86(2): 148－163.
［7］Ravi P, Kwak L, Devlies W, et al. Adjuvant and salvage radiotherapy after neoadjuvant therapy and radical prostatectomy for high-risk localized prostate cancer［J］. Prostate, 2024, 84(4): 342－348.
［8］Tilki D, Chen M H, Wu J, et al. Adjuvant versus early salvage radiation therapy for men at high risk for recurrence following radical prostatectomy for prostate cancer and the risk of death［J］. J Clin Oncol, 2021, 39(20): 2284－2293.
［9］Berhili S, Guerrouaz M A, Terrab F Z, et al. Immediate versus salvage postoperative radiotherapy in high-risk prostate cancer patients: a critical review［J］. Cureus, 2022, 14(8): e27678.
［10］Epstein J I, Egevad L, Amin M B, et al. The 2014 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system［J］. Am J Surg Pathol, 2016, 40(2): 244－252.
［11］赵强, 洪保安, 纪永鹏, 等. 局限高危前列腺癌患者根治性前列腺切除术后生化失败率及其影响因素分析［J］. 中华泌尿外科杂志, 2023, 44(3): 161－166.
［12］Axén E, Stranne J, Månsson M, et al. Biochemical recurrence after radical prostatectomy-a large, comprehensive, population-based study with long follow-up［J］. Scand J Urol, 2022, 56(4): 287－292.
［13］Shi R F, Huang D, Yan J Q, et al. phi and phiD predict adverse pathological features after radical prostatectomy for prostate cancer in Chinese population［J］. Cancer Med, 2024, 13(15): e70085.
［14］Guazzoni G, Lazzeri M, Nava L, et al. Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer［J］. Eur Urol, 2012, 61(3):455－466.
［15］Zhang X Y, Zhou G Q, Sun B, et al. Impact of obesity upon prostate cancer-associated mortality: a meta-analysis of 17 cohort studies［J］. Oncol Lett, 2015, 9(3): 1307－1312.
［16］Bhindi B, Locke J, Alibhai S M H, et al. Dissecting the association between metabolic syndrome and prostate cancer risk: analysis of a large clinical cohort［J］. Eur Urol, 2015, 67(1): 64－70.
［17］Ibrahim I, Kouli O, Ilangovan S, et al. Impact of centralisation of radical prostatectomy driven by the introduction of robotic systems on positive surgical margin and biochemical recurrence in pT2 prostate cancer［J］. Cancer Med, 2025, 14(2): e70514.
［18］范欣欢, 张妍, 朱琳琳, 等. 根治性前列腺切除术后切缘阳性的病理学不良特征对生化复发的影响［J］. 中华男科学杂志, 2025, 31(3): 202－207.
［19］Suh J, Jeong I G, Jeon H G, et al. Bilateral seminal vesicle invasion as a strong prognostic indicator in T3b prostate cancer patients following radical prostatectomy: a comprehensive, multicenter, long-term follow-up study［J］. Cancer Res Treat, 2024, 56(3): 885－892.
［20］Siddiqui S A, Boorjian S A, Blute M L, et al. Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer［J］. BJU Int, 2011, 107(3): 383－388.
［21］Devos G, Tosco L, Baldewijns M, et al. ARNEO: A randomized phase II trial of neoadjuvant Degarelix with or without apalutamide prior to radical prostatectomy for high-risk prostate cancer［J］. Eur Urol, 2023, 83(6): 508－518.
［22］Yi Z L, Li H H, Li M Y, et al. Androgen deprivation therapy, neoadjuvant androgen deprivation therapy, and adjuvant androgen deprivation therapy in patients with locally advanced prostate cancer: a multi-center real-world retrospective study［J］. World J Urol, 2024, 42(1): 581.

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