Oncologic Outcomes in a Contemporary "PROTEUS-like" Cohort of High-risk Prostate Cancer Treated with Radical Prostatectomy Without Neoadjuvant Hormonal Therapy
In brief
Only 22% of high-risk prostate cancer patients stay recurrence-free five years after surgery alone
In a single-center series of 1,392 men meeting PROTEUS high-risk criteria, biochemical recurrence-free survival dropped to 22% at ten years after radical prostatectomy without neoadjuvant therapy, while cancer-specific survival stayed above 85%. The poor long-term control highlights an unmet need for peri-operative treatment intensification, but the retrospective design limits definitive conclusions.
- Journal
- European urology open science (Q1)
- Published
- 24 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Can Aydogdu, Benso John, Clara Seizer, Frederik Kolligs, Iason Papadopoulos, Alexander Buchner, et al.
- PMID
- 42699359
- DOI
- 10.1016/j.euros.2026.08.001
Why clinicians should know about it
- Picked for Urology (paper of the day, 7 September 2026): High recurrence rates despite RP without neoadjuvant therapy
Abstract
BACKGROUND AND OBJECTIVE: High-risk prostate cancer (PCa) carries substantial risks of recurrence, metastasis, and mortality. Neoadjuvant therapy before radical prostatectomy (RP) remains investigational. The PROTEUS (NCT03767244) trial evaluates perioperative apalutamide + androgen deprivation therapy (ADT) but lacks a surgery-only control cohort. The objective of this study is to characterize oncologic outcomes in patients with PROTEUS-like high-risk PCa undergoing RP without neoadjuvant therapy. METHODS: We performed a retrospective, single-center cohort study of consecutive patients fulfilling PROTEUS high-risk criteria who underwent RP with lymphadenectomy without prior ADT or neoadjuvant treatment. The primary outcome was biochemical recurrence-free survival (BCR-FS). Secondary outcomes included metastasis-free survival (MFS), event-free survival (EFS), and cancer-specific survival (CSS). KEY FINDINGS AND LIMITATIONS: Among 1392 patients, median follow-up was 60 mo (95% confidence interval [CI], 56-64); 67% received postoperative radiotherapy. BCR-FS at 36, 60, and 120 mo was 60% (95% CI, 57-64), 44% (95% CI, 40-49), and 22% (95% CI, 17-28), respectively. MFS was 79% (95% CI, 76-83), 71% (95% CI, 66-76), and 56% (95% CI, 47-65), respectively. EFS was 56% (95% CI, 52-60), 40% (95% CI, 36-45), and 18% (95% CI, 13-23), respectively. CSS remained high at 95.5% (95% CI, 94-97), 92% (95% CI, 90-94), and 86% (95% CI, 81-91), respectively. Limitations include the retrospective, single-center design, absence of centralized pathology review, and maturing follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS: These findings demonstrate substantial rates of recurrence and metastatic progression despite contemporary management, underscoring the persistent unmet need in this population and providing a rationale for prospective evaluation of perioperative treatment intensification strategies such as PROTEUS.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.