Does adding local salvage ablation therapy provide survival advantage for patients with locally recurrent prostate cancer following radiotherapy?: Whole gland salvage ablation post-radiation failure in prostate cancer

IntroductionSome men who experience prostate cancer recurrence post-radiotherapy may be candidates for local salvage therapy, avoiding and delaying systemic treatments. Our aim was to assess the impact of clinical outcomes of adding salvage local treatment in prostate cancer patients who have failed radiation therapy.MethodsFollowing radiation biochemical failure, salvage transperineal cryotherapy (sCT, n=186), transrectal high intensity focused ultrasound ablation (sHIFU, n=113), or no salvage treatment (NST, identified from the pan-Canadian Prostate Cancer Risk Stratification [ProCaRS] database, n=982) were compared with propensity-score matching. Primary endpoints were cancer-specific survival (CSS) and overall survival (OS).ResultsMedian followup was 11.6, 25.1, and 14.3 years following NST, sCT, and sHIFU, respectively. Two propensity score-matched analyses were performed: 1) 196 NST vs. 98 sCT; and 2) 177 NST vs. 59 sHIFU. In the first comparison, there were 78 deaths and 49 prostate cancer deaths for NST vs. 80 deaths and 24 prostate cancer deaths for sCT. There were significant benefits in CSS (p<0.001) and OS (p<0.001) favoring sCT. In the second comparison, there were 52 deaths (31 from prostate cancer) for NST vs. 18 deaths (nine from prostate cancer) for sHIFU. There were no significant differences in CSS or OS possibility attributed to reduced sample size and shorter followup of sHIFU cohort.ConclusionsIn select men with recurrent prostate cancer post-radiation, further local treatment may lead to benefits in CSS. These hypothesis-generating findings should ideally be validated in a prospective clinical trial setting.     

The impact of hypertriglyceridemia on prostate cancer development in patients aged ≥60 years

Study Type – Aetiology (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Patients aged ≥60 years with high TG levels may be move vulnerable to the development of prostate cancer with aggressive biology. We urologists have to pay attention to select the treatment for patients aged ≥60 year with high TG levels.

OBJECTIVE

• ? To investigate the relationship between serum triglyceride (TG) levels and the incidence and characteristics of prostate cancer detected on biopsy.

PATIENTS AND METHODS

• ? We evaluated data from consecutive patients who underwent prostatic biopsy. Data analysed included age, total serum prostate‐specific antigen (PSA) level, prostatic volume, body mass index (BMI), TG levels, and cholesterol‐lowering medications.

RESULTS

• ? We analysed data from 905 patients, including 528 (58.3%) with positive biopsy findings.
• ? Using 150 mg/dL as the threshold point of TG levels, multivariate analysis yielded an adjusted odds ratio (OR) reflecting the association of higher TG levels with prostate cancer diagnosis of 1.66 (95% confidence interval (CI) 1.21–2.29, P = 0.002).
• ? Pearson correlation coefficient analysis including age, PSA level, prostatic volume, BMI and TG, showed TG level significantly correlated with BMI (r = 0.185, P < 0.001).
• ? In the analysis by age intervals (≤59, 60–69, and ≥70 years), the association between high TG levels and positive biopsy findings was enhanced in the age groups 60–69 and ≥70 years (OR 2.10, 95% CI 1.31–3.37, P = 0.002 and OR 1.91, 95% CI 1.03–3.53, P = 0.039, respectively), but not in the group aged ≤59 years.
• ? In patients aged ≥60 years, high TG levels were statistically significantly associated with a Gleason score of ≥8.

CONCLUSIONS

• ? High TG levels correlated well with a higher incidence of prostate cancer, especially in patients aged ≥60 years.
• ? High TG levels were also associated with a Gleason score of ≥8 in this age group.
• ? Our results suggest that elderly patients with high TG levels may be more vulnerable to the development of prostate cancer with an aggressive biology.

     

The presence of positive surgical margins in patients with organ-confined prostate cancer results in biochemical recurrence at a similar rate to that in patients with extracapsular extension and PSA≤10 ng/ml

PurposesWe investigated whether patients with organ-confined prostate cancer (PCa) and positive surgical margins (SMs) had a similar biochemical recurrence (BCR) risk compared with patients with pT3a and preoperative prostate-specific antigen (PSA) levels≤10 ng/ml. Furthermore, we examined the effects of incorporating SM status, Gleason score (Gls), and preoperative PSA level into the discrimination accuracy of the current tumor node metastasis-staging system.Materials and methodsWe analyzed 863 PCa patients treated with radical prostatectomy from 1999 to 2008. Only individuals with pT2N0 or pT3N0, without neoadjuvant or adjuvant therapy, were included. We performed chi-square automatic interaction detection analysis to generate a classification model for predicting BCR by analyzing interactions between age at surgery, SM status, Gls, PSA, and tumor stage, tumor volume and relative tumor volume. Cox regression analyses tested the relationship between SM status and BCR rate after stratification according to T-stage and the novel classification. The predictive and discrimination accuracy of the current T-stage and of the classification model was quantified with time-dependent receiver operating characteristics and integrated discrimination improvement. The topographical association between extracapsular extension of PCa and positive SM was analyzed in patients with pT3aR1 using a computational reconstruction diagram of the prostate.ResultsThe chi-square automatic interaction detection analysis found interactions among pT Stage, SM status, PSA and Gls and generated a classification model for BCR prediction: pT2R0, pT2R1, pT3a PSA≤10 ng/ml, pT3a PSA>10 ng/ml and pT3b. Men with pT2R1 had a shorter time to BCR compared with men with pT3a-PSA≤10 ng/ml (P<0.0001). Gls≥7a was correlated with a poorer BCR rate than Gls≤7a in men with pT2R1 or pT3a PSA≤10 ng/ml (P = 0.012). The rank order (highest to lowest) for the risk of developing BCR was pT3b>pT2R1/pT3a-PSA>10 ng/ml>pT2R1/pT3a PSA≤10 ng/ml>pT2R0 (P<0.0001). Discrimination accuracy gains were observed when PCa was stratified according to the novel classification (P<0.0001). A topographical association between extracapsular extension and positive SM was found in patients with pT3aR1 (P = 0.01).ConclusionPatients with pT2R1 develop a similar BCR risk to that of patients with pT3a PSA≤10 ng/ml. Gls≥7b is associated with a high BCR risk in these patient groups. Including SM status, PSA, and Gls in pT stage appears to improve prognostic stratification in patients with PCa.     

What is the real impact of bone pain on survival in patients with metastatic hormone‐refractory prostate cancer treated with docetaxel?

OBJECTIVES

To determine the benefit of starting early chemotherapy with docetaxel (the recommended first‐line treatment) for patients with asymptomatic metastatic hormone‐refractory prostate cancer (HRPC).

PATIENTS AND METHODS

Data were analysed from 145 patients with HRPC treated with chemotherapy between February 2000 and June 2002 in one French centre. Eligible patients were categorized into three groups according to the bone pain at baseline, i.e. minimal/no pain, mild, and moderate/severe pain. The primary endpoint was the effect of bone pain on overall survival (OS).

RESULTS

Docetaxel was administered to 67% of patients. The risk of death was 1.56 and 2.11 times higher for patients with mild or moderate/severe pain than for those with minimal/no pain (P = 0.027). The median (95% confidence interval (CI)) OS was 23.1 (18.5–27.6) and 14.1 (8.9–19.2) months (P = 0.001, log‐rank‐test) for patients with minimal pain or no pain treated with docetaxel‐based chemotherapy compared with mitoxantrone, respectively. The prostate‐specific antigen doubling time (PSA‐DT) had a significant effect on OS in patients with minimal/no pain, with a median of 32.4 and 16.5 months for a PSA‐DT of ≥45 and <45 days, respectively (P < 0.001).

CONCLUSIONS

Our results suggest that patients with HRPC and minimal or no bone pain could have better survival than those with mild pain or moderate to severe pain, independent of the treatment administered. In addition, patients with HRPC and minimal or no bone pain treated with docetaxel‐based chemotherapy have a significantly better OS than those treated with mitoxantrone. The PSA‐DT can be useful to identify asymptomatic patients who are candidates for early treatment.     

Comparison of oncologic outcomes after radical prostatectomy in men diagnosed with prostate cancer with PSA levels below and above 4 ng/mL

Purpose

To assess whether the PSA level (threshold 4 ng/mL) is a prognostic factor in biochemical recurrence-free survival in men with prostate cancer (PCa) with an initial PSA level <10 ng/mL who underwent robotic-assisted laparoscopic radical prostatectomy (RARLP).

Methods

We prospectively recruited data for consecutive patients treated by RARLP for PCa with an initial PSA level below 10 ng/mL between 2003 and 2011 at our institution. We divided the population into two groups: patients with a PSA level below 4 ng/mL (G1; n = 53) and patients with a PSA level between 4 and 10 ng/mL (G2; n = 371). Biochemical recurrence was defined as a single increase in PSA greater than 0.2 ng/mL after surgery. Multivariate analysis was used to assess prognostic factors of recurrence-free survival.

Results

Overall, 424 patients were included, and the median age was 62 (58–67) years. The median PSA was 5.8 ng/mL (4.8–7.7 ng/mL). Overall, 6 patients from G1 and 34 patients from G2 experienced a biochemical recurrence. Overall, the 5-year recurrence-free survival rate was 86.6 %. The PSA level at diagnosis (under or over 4 ng/mL) was not significantly linked to recurrence-free survival (HR = 0.59, p = 0.25). However, positive margins and a Gleason score >7 on the specimen were significantly linked to recurrence-free survival with respective hazard ratios of 4.30 (p < 0.0001) and 6.18 (p < 0.0001), respectively.

Conclusion

A PSA level <4 ng/mL alone appears to be obsolete as a cut-off to define a population of men likely to have indolent disease.     

Radical perineal prostatectomy without lymphadenectomy in patients with cT1 + 2, G1 + 2PSA ≤ 10 ng/ml prostate cancer

Summary Pelvic lymphadenectomy in patients with organ confined prostate cancer (PCa) is of no therapeutic value and is questionable in many patients because of the low incidence of metastases. 49 patients with ≤ cT2 b, G1 + 2, PSA ≤ 10 ng/ml underwent laparocopic pelvine lymphadenectomy and radical perineal prostatectomy. Only 1 patient (2 %) had microscopic metastases which were missed on frozen section. Because of these own results and those reported in the literature we then performed in patients with this constellation the radical perineal prostatectomy without lymphadenectomy (n = 32). The differences present in both groups concerning complication rate and morbidity are due to laparoscopic lymphadenectomy and the learning curve in perineal prostatectomy.      

MRI combined with PSA density in detecting clinically significant prostate cancer in patients with PSA serum levels of 4∼10 ng/mL: Biparametric versus multiparametric MRI

PurposeTo compare the performance of biparametric magnetic resonance imaging (bpMRI) to that of multiparametric MRI (mpMRI) in combination with prostate-specific antigen density (PSAD) in detecting clinically significant prostate cancer (csPCa) in patients with PSA serum levels of 4∼10 ng/mL.Materials and methodsA total of 123 men (mean age, 66.3 ± 8.9 [SD]; range: 42–83 years) with PSA serum levels of 4∼10 ng/mL with suspected csPCa were included. All patients underwent mpMRI at 3 Tesla and transrectal ultrasound-guided prostate biopsy in their clinical workup and were followed-up for >1 year when no csPCa was found at initial biopsy. The mpMRI images were reinterpreted according to the Prostate Imaging Reporting and Data System (PI-RADS, v2.1) twice in two different sessions using either mpMRI sequences or bpMRI sequences. The patients were divided into 2 groups according to whether csPCa was detected. The PI-RADS (mpMRI or bpMRI) categories and PSAD were used in combination to detect csPCa. Receiver operating characteristic (ROC) curve and decision curve analyses were performed to compare the efficacy of the different models (mpMRI, bpMRI, PSAD, mpMRI + PSAD and bpMRI + PSAD).ResultsThirty-seven patients (30.1%, 37/123) had csPCa. ROC analysis showed that bpMRI (AUC = 0.884 [95% confidence interval (CI): 0.814–0.935]) outperformed mpMRI (AUC = 0.867 [95% CI: 0.794–0.921]) (P = 0.035) and that bpMRI and mpMRI performed better than PSAD (0.682 [95% CI: 0.592–0.763]) in detecting csPCa; bpMRI + PSAD (AUC = 0.907 [95% CI: 0.841–0.952]) performed similarly to mpMRI + PSAD (AUC = 0.896 [95% CI: 0.828–0.944]) (P = 0.151) and bpMRI (P = 0.224). The sensitivity and specificity were 81.1% (95% CI: 64.8–92.0%) and 88.4% (95% CI: 79.7–94.3%), respectively for bpMRI, and 83.8% (95% CI: 68.0–93.8%) and 80.2% (95% CI: 70.2–88.0%), respectively for mpMRI (P > 0.999 for sensitivity and P = 0.016 for specificity). Among the 5 decision models, the decision curve analysis showed that all models (except for PSAD) achieved a high net benefit.ConclusionIn patients with PSA serum levels of 4∼10 ng/mL, bpMRI and bpMRI combined with PSAD achieve better performance than mpMRI in detecting csPCa; bpMRI has a higher specificity than mpMRI, which could decrease unnecessary biopsy, and may serve as a potential alternative to mpMRI to optimize clinical workup.     

The relation of prostate biopsy results and ratio of free to total PSA in patients with a total PSA between 4–20 ng/mL

Objective: In this study our aim was to investigate the efficacy of free tototal PSA ratio in discrimination of benign prostate hyperplasia andprostate cancer.Materials and methods: A total of 194 patients, 52 to 82 years old (mean66.06 ± 0.47 years) with PSA levels between 4 to 20 ng/mL wereincluded into this study. Each patient underwent sextant prostate biopsyunder transrectal ultrasound guidance. The patients were divided into twogroups as PSA 4–10 and 10–20 ng/mL. Patients with benign and malignresults were compared with respect to age, total PSA level, free PSA leveland free/total (f/t) PSA ratio.Results: Biopsies revealed prostate cancer in 16 of 130 patients (12.3%)with serum PSA 4–10 ng/mL and in 10 of 64 patients (15.6%) with serumPSA 10–20 ng/ml. In both PSA groups free PSA and f/t PSA levels werestatistically significant, where total PSA levels were not. In patients with4–20 ng/mL total PSA levels and a cut off level of < 0.18 for f/t PSA, thesensitivity, specificity and positive predictive value for prostate cancerwere 88.5%, 53.6% and 20.4% respectively.Conclusion: Higher levels of PSA suggest prostate cancer, but stilladditional parameters are needed for patients with PSA 4–20 ng/mL, suchas free PSA and f/t PSA. Although a cut off level of < 0.18 for f/t PSA seemsto be the most accurate one to discriminate benign and malign diseasesfurther studies on larger groups of patients are needed.     

Does cigarette smoking influence the survival of patients with prostate cancer?

In the last few years, prostate cancer has become one of the most common causes of mortality worldwide. It is therefore important to detect possible risk factors for this malignant disease. Besides risk factors which increase incidence, attention should be paid to factors which have a possible influence on the course of the disease. In our analysis, we demonstrate a worse course for the disease in patients with prostate cancer who smoked cigarettes at the time of first diagnosis. In spite of comparable staging, grading and PSA values at the time of primary diagnosis, individuals who smoked had a threefold higher risk of dying from prostate cancer. This effect is probably caused by metabolic changes which are activated by cigarette smoking and promote tumor growth and the development of metastases.     

Is free/total PSA predictive of pathological stage and Gleason score in patients with prostate cancer and serum PSA<or=10 ng/ml?

INTRODUCTION: To evaluate whether percent free prostate-specific antigen (%-fPSA) could be predictive of pathological stage and Gleason score in patients with prostate cancer (PCa) and serum PSA of 10 ng/ml or less. MATERIALS AND METHODS: In 100 patients with total PSA7 were compared. RESULTS: 32 patients had an organ-confined and 68 a locally advanced PCa. Median %-fPSA level was 15%; Gleasonscore was <7 in 49 patients, equal to 7 in 40 and >7 in 11. Median %-fPSA levels in PCa with Gleason score7 was 14, 15.5 and 15%, respectively. Multiple logistic regression analysis did not show any correlation between %-fPSA in organ-confined vs. non-organ-confined PCa (p=0.4991) either between Gleason score<7 vs. equal to 7 (p=0.588) or >7 (p=0.547). CONCLUSIONS: %-fPSA cut-off does not seem to be useful for preoperative staging of patients with PCa and serum PSA相似文献   

The impact of the “cisplatin era” of treatment on survival in testicular cancer

Summary The records of all testicular cancer patients evaluated and treated at our medical center during two consecutive 9-year periods were reviewed and analyzed for prognostic factors, particularly the impact of cisplatin-based combination chemotherapy. The data base of 244 patients was divided into two eras: 1970–1978, defined as the pre-cisplatin era (n=101) and 1979–1987, the cisplatin era (n=143). Statistically improved survival (P=0.024) was noted for the 165 nonseminoma patients and for a grouping of 143 patients treated with combination chemotherapy (P=0.004) during the cisplatin era. Stratification by stage revealed that stage II patients had the most significant survival advantage (P=0.001) during the cisplatin era; cancer mortality improved from 48% to 9%. Cancer death rates for stage III patients decreased from 58% to 39% which is clinically but not statistically significant (P=0.497). Stage I patients and the seminoma population did well during both eras, and the impact of cisplatin could not be statistically confirmed in this study for these subgroups. Multivariate statistical analysis confirmed the importance of the era of treatment for the nonseminoma population.     

Is it suitable to eliminate bone scan for prostate cancer patients with PSA ≤ 20 ng/mL?

Purpose  

We evaluated the relationship between bone metastasis (BM) and clinical or pathological variables, including the serum prostate-specific antigen (PSA) concentration.     

The prognosis and the impact of radiotherapy in clinically regional lymph node-positive prostate cancer: Which patients are candidates for local therapy with radiation?

BackgroundThis study aimed to identify the prognostic and predictive factors of local radiotherapy in clinically regional lymph node-positive prostate cancer.Patients and MethodsThis study includes patients who were newly diagnosed with regional lymph node-positive prostate cancer between 2008 and 2017. We investigated the prognostic value of clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) as well as the differential prognostic impact of radiotherapy by subgroup analysis.ResultsAmong the 93 men enrolled as patients, 48 (51.6 %) were treated with radiotherapy. The biopsy positive core rate and biopsy Gleason score were associated with PFS, and the number of lymph node metastases was associated with both PFS and OS. Patients who underwent radiotherapy showed better PFS and OS. High-risk features (at least 2 criteria among ≥75% biopsy positive core rate, Gleason score ≥9, and ≥2 positive lymph nodes) were especially associated with improved outcomes after undergoing radiotherapy.ConclusionWe identified prognostic factors for clinically regional lymph node-positive prostate cancer and showed the benefits of local radiation therapy. Patients with high-risk features may be especially suitable candidates for radiotherapy.     

The role of free to total PSA ratio in prediction of extracapsular tumor extension and biochemical recurrence after radical prostatectomy in patients with PSA between 4 and 10?ng/ml

Objectives

The prognostic value of free to total PSA ratio (F/T PSA) in patients eligible for radical prostatectomy (RP) is controversial. The aim of the present study was to evaluate correlation of F/T PSA with tumor extracapsular extension (ECE) and biochemical recurrence (BR) at long-term follow-up.

Patient and methods

Clinical and pathological data were prospectively gathered from 200 patients treated with RP for clinically localized prostate cancer (PCa) and PSA between 4 and 10?ng/mL. Correlations of preoperative variables including F/T PSA with ECE and BR were evaluated with uni- and multivariate analysis. Adjunctive analyses evaluated the association of PSA F/T with other pathological results. The relationship between preoperative F/T PSA and BR was also assessed with Kaplan?CMeier survival analysis.

Results

Lower F/T PSA was significantly correlated with ECE (p?=?0.0063), higher GS (p?=?0.0054), and seminal vesicles involvement (p?=?0.0047). The F/T PSA value of 14% provided the greatest discrimination in predicting ECE. At multivariate analysis, F/T PSA did not achieve the statistical significance for predicting ECE independently. At a mean (median, range) follow-up of 52 (48, 14?C116) months, preoperative F/T PSA resulted significantly correlated with BR (p?=?0.001). At the Kaplan?CMeier survival analysis, the 5-year BR free survival rate resulted 89.3 and 68.9% in the group with F/T PSA?>14 and ??14?ng/mL, respectively (log rank p?=?0.0022). At Cox proportional hazard model, only ECE resulted an independent predictor of BR (R?=?2.646, p?=?0.037).

Conclusion

In patients with clinically localized PCa and PSA 4?C10?ng/ml, lower F/T PSA was significantly associated with ECE, other adverse pathologic features, and with BR at the long-term follow-up, but only ECE resulted an independent predictor of BR in our series.     

Free/total PSA ratio can help in the prediction of high gleason score prostate cancer in men with total serum prostate specific antigen (PSA) of 3–10 ng/ml

Purpose We evaluate the use of free/total prostate specific antigen (PSA) ratio in improving the prediction of cancers of higher Gleason scores. Patients and methods A total of 164 patients with total serum PSA of 3.0–10.0 ng/ml underwent extended TRUS-guided core biopsy. In each man serum free PSA was measured and the free/total (F/T) PSA ratio was calculated. Out of the 164 patients who underwent TRUS-biopsy, cancer was detected in 62 (37.8%) patients. The mean age for the 62 patients with histologically proven prostate cancer was 62.3 ± 5.5 years (49–73). The histological findings were compared with the free/total PSA ratio. Pearson Correlation Coefficient test and Chi-Square test (χ²-test) were used for statistical analysis and p < 0.05 was considered statistically significant. ResultsOf the 62 patients, 37 (59.7%) patients had cancers of low Gleason scores (score 2–6) and 25 (40.3%) patients had cancers of high Gleason scores (score 7–10). Free PSA < 0.15% was found in 19 (30.6%) patients, from 15 to 20% in 23 (37.1%) patients and > 20% in 20 (32.3%) patients. There was a significant positive correlation between total PSA and Gleason score (Pearson Correlation Coefficient test, r = 0.328, p < 0.01). Also, there was a significant increase in Gleason score with lower F/T PSA ratio (r = −0.668, p < 0.001). Among the 19 patients with free PSA ratio < 15%, 14 (73.7%) patients had cancers of high Gleason score while 5 (26.3%) patients had cancers of low Gleason score. In patients (n = 23) with free PSA ratio15–20%, 10 (43.5%) had cancers of high Gleason score and 13 (56.5%) had cancers of low Gleason score. In the 20 patients with free PSA ratio > 20%, 1 patient (5%), had prostate cancer of high Gleason score and the remaining 19 (95%) patients had low Gleason scores. There was a significant relation between lower F/T PSA ratios and higher Gleason scores, Chi-Square test, χ² = 19.3, p < 0.01. Conclusions In this study, men with prostate cancer and lower F/T PSA ratio were at a higher risk of having higher Gleason scores (7–10) and those with higher F/T PSA ratio were more likely to have lower Gleason scores.     

Impact of systemic Immune–inflammation Index on oncologic outcomes in patients treated with radical prostatectomy for clinically nonmetastatic prostate cancer

PurposeTo evaluate the predictive and prognostic value of the Systemic Immune–inflammation Index (SII) in a large cohort of patients treated with radical prostatectomy (RP) for clinically non–metastatic prostate cancer (PCa).MethodsWe retrospectively analyzed our multicenter database comprising 6,039 consecutive patients. The optimal preoperative SII cut–off value was assessed with the Youden index calculated on a time–dependent receiver operating characteristic (ROC) curve. Logistic regression and Cox regression analyses were used to investigate the association of SII with pathologic features and biochemical recurrence (BCR), respectively. The discriminatory ability of the models was evaluated by calculating the concordance-indices (C-Index). The clinical benefit of the implementation of SII in clinical decision making was assessed using decision curve analysis (DCA).ResultsPatients with high preoperative SII (≥ 620) were more likely to have adverse clinicopathologic features. On multivariable logistic regression analysis, high preoperative SII was independently associated with extracapsular extension (odds ratio [OR] 1.16, P = 0.041), non–organ confined disease (OR 1.18, P = 0.022), and upgrading at RP (OR 1.23, P < 0.001). We built two Cox regression models including preoperative and postoperative variables. In the preoperative multivariable model, high preoperative SII was associated with BCR (hazard ratio [HR] 1.34, 95% CI 1.15-1.55, P < 0.001). In the postoperative multivariable model, SII was not associated with BCR (P = 0.078). The addition of SII to established models did not improve their discriminatory ability nor did it increase the clinical net benefit on DCA.ConclusionIn men treated with RP for clinically nonmetastatic PCa, high preoperative SII was statistically associated with an increased risk of adverse pathologic features at RP as well as BCR. However, it did not improve the predictive accuracy and clinical value beyond that obtained by current predictive and prognostic models. SII together with a panel of complementary biomarkers is praised to help guide decision–making in clinically nonmetastatic PCa.