Validating the association of adverse pathology with distant metastasis and prostate cancer mortality 20-years after radical prostatectomy

•Due to slow progression, intermediate endpoints are often used in prostate cancer studies•Useful intermediate endpoints reliably predict metastasis and cancer-specific mortality•Adverse pathology at radical prostatectomy predicts metastasis and mortality at 20 years•Adverse pathology is a stronger predictor of metastasis than either of its components, high stage and high grade, alone•Adverse pathology is a reliable intermediate endpoint for prostate cancer studies