title: Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors.
abstract: BACKGROUND
  High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors.
  
  
  METHODS
  We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL).
  
  
  RESULTS
  We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3).
  
  
  CONCLUSIONS
  The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.
authors.affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Aguilera
authors.affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bañuelos
authors.affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Díez
authors.affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Jose María
authors.initials: JM
authors.lastname: Alonso-Dorrego
authors.affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Cisneros
authors.affiliation: Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Peña
keywords: biochemical recurrence; prostate cancer; risk factors