The prognostic value of PTEN expression in localized prostate cancer.

Purpose: Current risk stratification systems for prostate cancer (PCa) lack precision, particularly for intermediate-risk patients. PTEN loss has emerged as a promising biomarker for predicting aggressive disease. This study aims to evaluate the prognostic value of PTEN status in patients diagnosed via magnetic resonance imaging (MRI)-targeted biopsy and treated with radical prostatectomy (RP).

Methods: A retrospective analysis was conducted on a cohort of 213 patients diagnosed via MRI-targeted biopsy with available PTEN testing between 2020 and 2023 at a referral center. Patients who underwent RP with undetectable postoperative PSA levels and a minimum follow-up of three months were included. The primary outcome was the prognostic value of PTEN status. Biochemical recurrence (BCR) after RP was analyzed using Kaplan-Meier analysis and the log-rank test, while Cox regression models identified predictors of BCR.

Results: Overall, 36/213 (17%) patients exhibited PTEN loss. These patients had more aggressive disease, characterized by higher clinical stage and ISUP grade group (p ≤ 0.01). Among the 56 patients treated with RP and followed for a median of 25 months, BCR-free survival was significantly lower in those with PTEN loss, especially in the intermediate-risk subgroup (log-rank test, p = 0.03). PTEN loss was identified as an independent predictor of BCR (Hazard Ratio: 8.5, p = 0.03).

Conclusion: PTEN loss in patients diagnosed via MRI-targeted biopsy and treated with RP is associated with worse prognosis. PTEN testing shows promise as a biomarker to improve patient counseling and guide PCa treatment decisions. Prospective studies with longer follow-up periods are needed to validate these findings fully.