Radical Prostatectomy (RP) remains a key treatment method for localized Prostate Cancer (PCa). However, a significant portion of patients (about 35%) eventually develop Biochemical Recurrence (BCR), posing a complex challenge for urologists regarding the precise localization of recurrence.

Traditional methods, including Transrectal Biopsy of the prostate bed under ultrasound guidance, demonstrate low sensitivity (only 28.5% in this study), necessitating the search for more accurate diagnostic approaches.

This study analyzed data from 296 patients who underwent RP to evaluate the efficacy of diagnostic methods and identify Prognostic Factors for positive results from multifocal biopsy of the Urethrovesical Anastomosis (UVA) area.

 Key Prognostic Factors and Conclusions

Diagnostic Limitations: Low sensitivity of traditional biopsy and MRI (22.2%) was confirmed at low postoperative PSA levels. PSA Kinetics and the time interval to BCR remain important indicators.

Significant Predictors of Recurrence: Univariate analysis revealed several parameters that statistically significantly correlate with a positive biopsy result from the prostate bed:

High preoperative total PSA (\text{p}=0.026) and PSA Density (\text{p}=0.012).

Positive Surgical Margin (\text{p}=0.012).

Extracapsular Extension (\text{p}=0.006) and Seminal Vesicle Invasion (\text{p}=0.014).

Seminal Vesicle Invasion (SVI) is a critical factor indicating a high risk of progression and extremely low long-term recurrence-free survival rates.

Overall Conclusion: None of the current radiological methods are perfect. Utilizing the identified Prognostic Factors allows for a more accurate determination of the high-risk patient group and enhances the effectiveness of Targeted Biopsy, reducing the rate of false-negative results.

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