Impact of Biopsy-to-Radical Prostatectomy Interval on Adverse Pathological Outcomes in High-Risk Localized and Locally Advanced Prostate Cancer

Background: In high-risk prostate cancer, the optimal timing of radical prostatectomy after diagnostic biopsy remains a clinically important issue. A real-world delay between diagnosis and radical treatment frequently occurs, raising concerns about potential disease progression in high-risk patients. Methods: We conducted a single-center retrospective study including patients with high-risk localized and locally advanced prostate cancer who underwent radical prostatectomy from January 2016 to January 2026. Patients were stratified according to biopsy-to-radical prostatectomy interval into two groups: <90 days or ≥90 days. Adverse pathological outcomes were defined as extraprostatic extension, seminal vesicle involvement, positive surgical margins and lymph-node involvement. Univariable comparisons and multivariable logistic regression analyses were performed to identify independent predictors of adverse pathology. Results: A total of 158 patients with high-risk prostate cancer were included, of whom 67 (42.4%) underwent open- or laparoscopic radical prostatectomy within 90 days after biopsy and 91 (57.6%) after ≥90 days. On univariable analysis, the rates of extraprostatic extension were 59.7% vs. 63.7% in the <90-day and ≥90-day groups (p = 0.606), seminal vesicle involvement was observed in 22.4% vs. 24.2% (p = 0.627), positive surgical margins in 35.8% vs. 39.6% (p = 0.632), and lymph node involvement in 6% vs. 5.5% (p = 0.999). In multivariable logistic regression, a biopsy-to-radical prostatectomy interval ≥90 days was not independently associated with extraprostatic extension (OR 1.38, 95% CI 0.68–2.77, p = 0.371), seminal vesicle involvement (OR 1.43, 95% CI 0.63–3.27, p = 0.391) or positive surgical margins (OR 1.31, 95% CI 0.66–2.62, p = 0.443). The number of positive biopsy cores independently predicted extraprostatic extension (OR 1.17, 95% CI 1.04–1.32, p = 0.008), while higher PSA independently predicted seminal vesicle involvement (OR 1.05, 95% CI 1.01–1.10, p = 0.025) and positive surgical margins (OR 1.05, 95% CI 1.00–1.10, p = 0.027). Conclusions: In this real-world cohort of patients with high-risk prostate cancer undergoing radical prostatectomy, no statistically significant independent association was detected between a biopsy-to-radical prostatectomy interval ≥90 days and extraprostatic extension, seminal vesicle involvement, or positive surgical margins. However, the confidence intervals remained compatible with potentially clinically meaningful differences, and residual confounding from clinician-driven prioritisation and unmeasured preoperative factors cannot be excluded. Therefore, these findings should not be interpreted as demonstrating equivalence or the safety of delaying surgery.