What is the median time to biochemical recurrence after radical prostatectomy in prostate cancer?
Executive summary
The median time to biochemical recurrence (BCR) after radical prostatectomy (RP) is not a single fixed number but typically falls in the 20–38 month window (roughly 1.7–3.2 years) in contemporary series, with many cohort-level medians clustering around ~2.5–3 years (∼2.9 years reported in some institutional series) [1] [2]. Reported medians vary by study design, BCR definition, and the risk profile of the operated population, so clinicians interpret any single median in context of pathology, PSA kinetics, and imaging [3] [4] [5].
1. What the question actually asks and why a single number is elusive
Asking for the “median time to biochemical recurrence after radical prostatectomy” seeks a central tendency of when PSA rises to predefined thresholds after surgery, but BCR is defined variably (commonly two consecutive PSA ≥0.2 ng/mL after RP, though lower cutoffs and timing rules exist), and cohorts differ by baseline PSA, Gleason/Grade Group, stage and follow-up intensity—factors that produce different medians across studies [3] [5] [6].
2. The published signals: reported medians and ranges
Multiple reviews and imaging-focused series summarize contemporary data showing that 20–40% of men will experience BCR within 10 years and that the median time to BCR after RP in many pooled and institutional datasets lies between 20 and 38 months (about 1.7–3.2 years) [1] [6] [3]. Single‑institution studies using long-term PSA-era cohorts have reported a median time to recurrence of roughly 2.9 years in their populations, a number used to dichotomize early versus late recurrence in predictive modeling [2] [7].
3. Why different studies report different medians — the mechanics behind variation
Variation stems from differing BCR definitions (PSA thresholds and required confirmatory tests), patient selection (higher‑risk pathologic features produce earlier recurrence), follow-up duration and intensity, and era of surgery and perioperative imaging; for example, modern series with more aggressive pathology or inclusion of node‑positive disease shift medians earlier, while long‑term Scandinavian cohorts emphasize late events and show continuing risk years after surgery [5] [4] [8]. Advanced imaging and earlier salvage treatments also alter the apparent timing and clinical import of PSA rises [9] [10].
4. Clinical meaning of timing — why median time matters for risk stratification
Time from surgery to PSA relapse is itself predictive: shorter intervals to BCR (commonly defined clinically as <2 years) identify patients at higher risk for subsequent metastasis and prostate cancer mortality, whereas late recurrences often carry a more indolent natural history; guidelines and consensus statements therefore use time-to-recurrence alongside PSA doubling time, pathologic Grade Group, and imaging to guide salvage imaging and therapy [11] [12] [9]. Longitudinal cohorts also show that even after BCR, median systemic progression‑free and cancer‑specific survival may not be reached for many years, reinforcing that timing alters prognosis but is not determinative alone [12] [10].
5. Practical takeaway and limits of current evidence
For practical purposes, contemporary literature supports citing a typical median time to biochemical recurrence after radical prostatectomy of about 20–38 months, with institutional cohorts often reporting medians near 2.5–3 years [1] [2]. That range must be contextualized by BCR definition, tumor grade/stage, postoperative management and PSA surveillance intensity; available sources do not permit a single universal median for every clinical setting, and individual prognosis requires integration of clinicopathologic variables, PSA kinetics and modern imaging [3] [4] [9].