Abstract
BACKGROUND: Prostate cancer (PCa) remains a major clinical challenge, with postoperative recurrence risk varying substantially among patients. Emerging evidence suggests that serum biomarkers, including α-methylacyl-CoA racemase (AMACR) and zinc finger protein-like 1 (ZFPL1), may provide additional prognostic information beyond conventional clinicopathological factors. MATERIALS AND METHODS: This single-center retrospective study included 115 patients with PCa who underwent radical prostatectomy. Serum AMACR and ZFPL1 levels were analyzed in combination with clinicopathological variables. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of recurrence. A risk nomogram was constructed, and model performance was evaluated using receiver operating characteristic (ROC) curve analysis and Kaplan-Meier survival analysis. RESULTS: Poor postoperative outcomes were significantly associated with advanced age, lymph node metastasis, higher TNM stage, poor tumor differentiation, and higher Gleason score. Serum AMACR and ZFPL1 levels were significantly elevated in patients who experienced recurrence. Multivariate analysis identified both biomarkers as independent predictors of recurrence. The resulting nomogram demonstrated strong discriminative performance and stable predictive accuracy across multiple postoperative time points. CONCLUSION: Elevated serum AMACR and ZFPL1 levels independently predict recurrence following radical prostatectomy in patients with PCa. The proposed nomogram integrates molecular and clinicopathological factors to provide accurate postoperative risk stratification, supporting individualized follow-up and management, with robust performance observed up to 3 years after surgery.