Work

Natural History and Risk Stratification of Biochemically Recurrent Prostate Cancer Following Definitive Radiation Therapy

Year: 2025

Type: article

Abstract: Background Among patients with biochemical recurrent (BCR) prostate cancer following radiation therapy, there is no validated method for identifying those at highest risk for metastases or death from prostate cancer. We characterized the natural history of BCR after radiation therapy and validated the proposed European consensus guidelines for stratification. Patients and Methods This retrospective, multicenter, nationwide cohort study used data from patients having post-radiation BCR treated in the United States Veterans Administration Health System. High-risk BCR was defined as either Gleason score ≥8 or BCR occurring within 18 months of radiation therapy, per guidelines. Results Among 7,126 patients who experienced BCR, 35.5% of patients developed metastatic disease and 17.4% died of prostate cancer at 10-years. 38.5% of patients had a high-risk BCR. High-risk BCR resulted in higher 10-year incidence of metastatic disease (56.2% versus 42.0%, adjusted hazard ratio (aHR)=1.83, 95% confidence interval (CI): 1.69-1.98) and worse prostate cancer-specific survival (69.5% versus 81.6%, aHR=1.82, 95% CI=1.63-2.03, p<0.001) and all-cause death (67.8% versus 65.0%, aHR=1.18, 95% CI=1.11-1.26, p<0.001). Conclusions A simple, two-element risk stratification tool using existing clinically data is the first validated tool for identifying patients at risk of metastases or PCSM following post-radiation BCR. Most patients experiencing BCR in this context do not develop metastases or lethal prostate cancer, making such stratification essential for treatment decision-making and refinement of patient populations for clinical trials.

Source: Advances in Radiation Oncology

DOI: 10.1016/j.adro.2025.101936