A New Predictive Tool for the Post-surgical Risk of Recurrence of Prostate Cancer Potentially Unveiling Hidden Residual Disease

Background: 20-25% of patients affected by prostate cancer relapses in the first 5 years after radical prostatectomy. Risk assessment is normally performed on consolidated parameters relating the peri-operative tumor characteristics, namely tumor staging, nodal involvement, positive margins, pathological Gleason Score and pre-surgery PSA values. Methods: Based on the EUREKA-1 database, which collected clinical data from a large cohort of prostatectomized Italian patients, we validated three different models, which differ in the splitting of the pGS=7 patients in 3+4 and 4+3 cases and in the inclusion of the first post-surgery PSA value. Results: Differences in the ROC curves’ AUC were detected, which are highly significant (73%) when the first post- surgical PSA is accounted for in the evaluation of the risk of tumor recurrence. Conclusions: Early post-surgical PSA evaluation, besides being the starting point for long-time monitoring and a very sensible ‘alarm-bell’ when the biochemical recurrence threshold i