放射治疗和/或消融治疗后复发的GS 6前列腺癌（PCa）的行为尚未受到研究。评估GS 6 PCa复发后进行sRP的肿瘤学结果。从2000年至2021年，收集了14个三级转诊中心中关于局部非手术治疗后复发PCa的sRP的回顾性数据。前sRP活检和sRP。对前sRP活检和sRP证实的GS 6进行生存分析。评估前sRP活检和sRP组织学之间的一致性。我们包括前sRP活检（n = 142）和sRP（n = 50）的GS 6复发PCa作为两个队列。在前sRP活检中，大部分患者在本次活检前接受了放射治疗和/或插入治疗（83.8％的GS 6患者），全腺治疗（91％活检）。活检GS 6的10年转移、癌特异性生存（CSS）和总生存率（OS）分别为79％（95％可信区间[CI] 61-89％）、98％（95-99％）和89％（78-95％）。sRP期间的升级率为69％，35.5％的患者处于pT3阶段，13.4％的患者有阳性淋巴结。sRP GS 6的10年转移无病生存率，CSS和OS分别为100％、100％和90％（95％CI 58-98％）；分别在12％和0％的患者中发现了pT3和pN1疾病。总体并发症、高级并发症和严重尿失禁分别超过50％、超过10％和超过15％的男性经历了这些症状（在活检队列和sRP队列中都是如此）。研究局限性包括研究的回顾性性质和缺乏集中病理学评审。在非手术一线治疗后复发的GS 6 sRP证实的PCa几乎没有转移潜力，但患者在该手术中经历了相关的病变。然而，很大一部分前sRP活检的GS 6病例在sRP中升级。为了避免过度治疗，应该努力提高sRP前活检的诊断准确性。

Salvage radical prostatectomy (sRP) yields poor functional outcomes and relatively high complication rates. Gleason score (GS) 6 prostate cancer (PCa) has genetic and clinical features showing little, if not absent, metastatic potential. However, the behavior of GS 6 PCa recurring after previous PCa treatment including radiotherapy and/or ablation has not been investigated.To evaluate the oncological outcomes of sRP for radio- and/or ablation-recurrent GS 6 PCa.Retrospective data of sRP for recurrent PCa after local nonsurgical treatment were collected from 14 tertiary referral centers from 2000 to 2021.Prostate biopsy before sRP and sRP.A survival analysis was performed for pre-sRP biopsy and sRP-proven GS 6. Concordance between PCa at pre-sRP biopsy and sRP histology was assessed.We included GS 6 recurrent PCa at pre-sRP biopsy (n = 142) and at sRP (n = 50), as two cohorts. The majority had primary radiotherapy and/or brachytherapy (83.8% of GS 6 patients at pre-sRP biopsy; 78% of GS 6 patients at sRP) and whole-gland treatments (91% biopsy; 85.1% sRP). Biopsy GS 6 10-yr metastasis, cancer-specific survival (CSS), and overall survival (OS) were 79% (95% confidence interval [CI] 61-89%), 98% (95-99%), and 89% (78-95%), respectively. Upgrading at sRP was 69%, 35.5% had a pT3 stage, and 13.4% had positive nodes. The sRP GS 6 10-yr metastasis-free survival, CSS, and OS were 100%, 100%, and 90% (95% CI 58-98%) respectively; pT3 and pN1 disease were found in 12% and 0%, respectively. Overall complications, high-grade complications, and severe incontinence were experienced by >50%, >10%, and >15% of men, respectively (in both the biopsy and the sRP cohorts). Limitations include the retrospective nature of the study and absence of a centralized pathological review.GS 6 sRP-proven PCa recurring after nonsurgical primary treatment has almost no metastatic potential, while patients experience relevant morbidity of the procedure. However, a significant proportion of GS 6 cases at pre-sRP biopsy are upgraded at sRP. In the idea not to overtreat, efforts should be made to improve the diagnostic accuracy of pre-sRP biopsy.We investigated the oncological results of salvage radical prostatectomy for recurrent prostate cancer of Gleason score (GS) 6 category. We found a very low malignant potential of GS 6 confirmed at salvage radical prostatectomy despite surgical complications being relatively high. Nonetheless, biopsy GS 6 was frequently upgraded and had less optimal oncological control. Overtreatment for recurrent GS 6 after nonsurgical first-line treatment should be avoided, and efforts should be made to increase the diagnostic accuracy of biopsies for recurrent disease.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.