In this cohort, the factors that were significantly predictive of pathologic features and biochemical recurrence after prostate surgery were: seminal vesicle invasion on magnetic resonance imaging (MRI), the long diameter of the largest MRI lesion, and targeted fusion biopsy International Society of Urological Pathology (ISUP) grade group. Risk stratification combining the three parameters could better predict the biochemical recurrence compared with the conventional model.

• A total of 304 patients undergoing radical surgery for prostate cancer between 2009 and 2020 were included to ascertain the prostate cancer biochemical recurrence-related fusion biopsy characteristics prior to radical surgery as well as to establish the risk prediction model of biochemical recurrence of prostate cancer.

• The following factors were associated with higher biochemical recurrence rates, higher pathological staging, and a greater likelihood of local lymph node metastasis: Higher Prostate Imaging Reporting And Data System (PI-RADS) scores, suspicious extracapsular invasion, and seminal vesicle invasion on MRI, the largest lesion diameter on MRI, higher biopsy ISUP grade group.

• Accurate prediction of biochemical recurrence post-radical surgery was achieved based on preoperative features such as the long diameter of the largest MRI lesion more than 23 mm, seminal vesicle invasion on MRI, and targeted fusion biopsy ISUP grade >3 Risk stratified classification (AUC = 0.729).