Risk Stratification of Patients with Recurrence After Primary Treatment for Prostate Cancer: A Systematic Review.

Biochemical recurrence (BCR) after primary definitive treatment for prostate cancer (PCa) is a heterogeneous disease state. While BCR is associated with worse oncologic outcomes, risk factors that impact outcomes can vary significantly, necessitating avenues for risk stratification. We sought to identify prognostic risk factors at the time of recurrence after primary radical prostatectomy or radiotherapy, and prior to salvage treatment(s), associated with adverse oncologic outcomes.

We performed a systematic review of prospective studies in EMBASE, MEDLINE, and ClinicalTrials.gov (from January 1, 2000 to October 16, 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42023466330). We reviewed the factors associated with oncologic outcomes among patients with BCR after primary definitive treatment.

A total of 37 studies were included (total n = 10 632), 25 after prostatectomy (total n = 9010) and 12 after radiotherapy (total n = 1622). Following recurrence after prostatectomy, factors associated with adverse outcomes include higher pathologic T stage and grade group, negative surgical margins, shorter prostate-specific antigen doubling time (PSADT), higher prostate-specific antigen (PSA) prior to salvage treatment, shorter time to recurrence, the 22-gene tumor RNA signature, and recurrence location on molecular imaging. After recurrence following radiotherapy, factors associated with adverse outcomes include a shorter time to recurrence, and shorter PSADT or higher PSA velocity. Grade group, T stage, and prior short-term hormone therapy (4-6 mo) were not clearly associated with adverse outcomes, although sample size and follow-up were generally limited compared with postprostatectomy data.

This work highlights the recommendations and level of evidence for risk stratifying patients with PCa recurrence, and can be used as a benchmark for personalizing salvage treatment based on prognostics.

We summarize the data from previously reported clinical trials on the topic of which factors predict worse cancer outcomes for patients who recur with prostate cancer after their initial treatment.

European urology. 2024 May 22 [Epub ahead of print]

Adam B Weiner, Preeti Kakani, Andrew J Armstrong, Alberto Bossi, Philip Cornford, Felix Feng, Pratik Kanabur, R Jeffery Karnes, Rana R Mckay, Todd M Morgan, Edward M Schaeffer, Neal Shore, Alison C Tree, Daniel E Spratt

Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California Los Angeles, Los Angeles, CA, USA., Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA., Division of Medical Oncology, Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, NC, USA., Amethyst Radiotherapy Group, La Garenne Colombes, France., Liverpool University Hospitals NHS Trust, Liverpool, UK., Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Medicine, Department of Urology, University of California San Diego, La Jolla, CA, USA., Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Carolina Urologic Research Center, Myrtle Beach, SC, USA., Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK., Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA. Electronic address: .