Real-world clinical outcomes among patients with localized prostate cancer (LPC) undergoing radical prostatectomy (RP).

343 Background: RP is a curative option for LPC. While prognosis is generally favorable, patients with high-risk (HR) features face greater risk of recurrence and progression than those with low- or intermediate-risk (L/IR) disease. This study compared long-term outcomes of HR vs L/IR LPC patients treated with RP in the United States (US). Methods: This retrospective study used linked data from US community urology practices and administrative claims (PPS Analytics and Komodo Research Database; 1/1/2016–8/31/2024). The RP date served as the index date. Patients were stratified by HR vs L/IR status per NCCN guidelines based on TNM staging, Gleason score, and prostate-specific antigen level. Patients with metastasis, castration resistance, or advanced treatment before RP were excluded. Baseline characteristics (12 months pre-index) were balanced using inverse probability of treatment weighting. Outcomes including metastasis-free survival (time from index date to metastasis or death) and event-free survival (index date to biochemical recurrence, metastasis, or death) were compared via weighted Kaplan-Meier analyses and hazard ratios with 95% confidence intervals (CIs). Results: Overall, 18,971 patients with LPC were identified: 7,542 HR and 11,429 L/IR. After weighting, baseline characteristics were balanced between HR patients (mean age: 63.9 years, white: 52.6%, Medicare-insured: 46.8%, commercial-insured: 45.5%, median time from LPC diagnosis: 2.5 months, mean follow-up: 47.1 months) and L/IR patients (mean age: 63.6 years, white: 52.5%, Medicare-insured: 45.7%, commercial-insured: 46.7%, median time from LPC diagnosis: 2.8 months, mean follow-up 47.1 months). By 60 months, HR patients had a 3.59 greater rate of metastasis or death relative to L/IR patients (95% CI: 3.19, 4.04; p<0.001; Table). Rates of biochemical recurrence, metastasis, or death were also significantly higher in HR patients by 60 months (hazard ratio: 3.37; 95% CI: 3.18, 3.57; p<0.001). Conclusions: In this real-world analysis of patients with LPC treated with RP, those with HR disease had significantly worse metastasis-free and event-free survival than L/IR patients. These results highlight the greater clinical burden in HR LPC and the need for more effective treatment options. Clinical outcomes. Metastasis-free survival Event-free survival Kaplan-Meier rate High Risk Low/ Intermediate-risk High Risk Low/ Intermediate-risk 12 months 94.8% 98.9% 71.8% 92.0% HR (95% CI) 4.71 (3.86, 5.74); p<0.001 4.01 (3.71, 4.33); p<0.001 24 months 92.9% 98.2% 63.2% 88.1% HR (95% CI) 4.08 (3.46, 4.80); p<0.001 3.68 (3.45, 3.93); p<0.001 48 months 87.0% 96.4% 53.8% 82.9% HR (95% CI) 3.81 (3.35, 4.33); p<0.001 3.44 (3.24, 3.65); p<0.001 60 months 84.3% 95.1% 50.8% 80.7% HR (95% CI) 3.59 (3.19, 4.04); p<0.001 3.37 (3.18, 3.57); p<0.001 CI: confidence interval; HR: hazard ratio.