Identification of men with the highest risk of early disease recurrence after radical prostatectomy

BACKGROUND Men destined to have early biochemical recurrence (BCR) following radical prostatectomy (RP) may be optimal candidates for multimodal treatment. Here we identified pre‐operative predictors of early BCR within a surgical cohort who recurred. METHODS An institutional prostate cancer (PCa) database containing over 20,000 patients was queried to identify 1,471 men who had BCR after RP, and pre‐operative predictors of early versus late BCR were assessed. Early BCR was defined as recurrence within 1 year after RP. Within the recurrence cohort, those with National Comprehensive Cancer Network (NCCN) high‐risk features were more likely to experience early BCR. Therefore, in all NCCN high‐risk men in the database, we ed detailed pathologic biopsy data. Among 753 high‐risk men, 41 alternate multivariable criteria were assessed for their ability to predict early BCR in crude and adjusted logistic regression models. RESULTS The criteria that best identified those likely to experience early BCR are primary Gleason pattern 5 on biopsy or ≥4 cores containing pattern 4 (odds ratio 3.17, P