ABSTRACT Objectives We investigated the clinical characteristics and prognostic significance of late biochemical recurrence (BCR) in patients who underwent robot‐assisted radical prostatectomy (RARP), with a specific focus on recurrences occurring ≥ 5 years after surgery. Methods A retrospective review was conducted of 1106 patients who underwent RARP at our institution between 2011 and 2023. Among them, 552 patients were followed for at least 5 years and stratified into three groups: No recurrence, early recurrence (before 5 years), and late recurrence (at or after 5 years). Univariable and multivariable Cox proportional hazards models were used to identify predictors of late recurrence. Kaplan–Meier survival analyses were used to evaluate long‐term oncological outcomes. In addition, comparative analyses were performed with a cohort of patients who experienced early recurrence. Results Of the 552 patients, 152 experienced early recurrence and 32 experienced late recurrence. Multivariable analysis identified lymphovascular invasion and seminal vesicle invasion as risk factors for late recurrence. None of the patients with late BCR progressed to castration‐resistant prostate cancer during the follow‐up period; whereas 11% of those with early recurrence developed castration‐resistant disease. Conclusions Late BCR following RARP is not uncommon and is associated with elevated risk in patients exhibiting lymphovascular invasion or seminal vesicle invasion. Patients lacking these pathological features may be appropriate candidates for de‐escalated surveillance beyond 5 years postoperatively; whereas those with identified risk factors warrant continued close monitoring to facilitate timely intervention.
Nishino et al. (Sun,) studied this question.
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