{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:56:42Z","timestamp":1773017802837,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In 2025, the National Comprehensive Cancer Network (NCCN) updated the definition of very high\u2010risk (VHR) prostate cancer to include individuals meeting at least two of the following: clinical stage\u2009\u2265\u2009T3, prostate\u2010specific antigen\u2009\u2265\u200940\u2009ng\/mL, and Gleason Grade Group (GG)\u2009\u2265\u20094. This revision alters group classification and may impact surgical outcomes. We aimed to compare oncological outcomes under the earlier and 2025 definitions in individuals undergoing robot\u2010assisted radical prostatectomy (RARP) without perioperative systemic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 1879 individuals who underwent RARP at two institutions between July 2012 and November 2022. Of these, 641 classified as high risk or above were analyzed: historical high risk (Group 1:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009377), reclassified from VHR to high risk (Group 2:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009119), and VHR per 2025 criteria (Group 3:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009145).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median follow\u2010up was 59.8\u2009months. Five\u2010year biochemical recurrence\u2010free survival rates were 71.1%, 44.7%, and 29.8%; metastasis\u2010free survival rates were 99.6%, 94.1%, and 88.9% for the three groups, respectively. Group 2 showed worse outcomes than Group 1. Exploratory analyses indicated that within Group 3, having &gt;\u20094 biopsy cores with GG 4\u20135 was associated with significantly worse recurrence outcomes, whereas those without this factor had results closer to Group 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, both the revised high\u2010risk and VHR categories include heterogeneous populations. Refinement of risk stratification in the surgical setting may help identify subsets requiring tailored perioperative and multimodal strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70366","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T10:43:43Z","timestamp":1770029023000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the 2025\n                    <scp>NCCN<\/scp>\n                    Definition Change for Very High\u2010Risk Prostate Cancer on Surgical Outcomes After Robot\u2010Assisted Radical Prostatectomy: A\u00a0Retrospective Cohort"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2229-0948","authenticated-orcid":false,"given":"Noriyoshi","family":"Miura","sequence":"first","affiliation":[{"name":"Department of Urology Ehime University Graduate School of Medicine  Toon 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