Describe real-world anticancer treatment patterns in the USA among patients with prostate cancer (PC) who experience biochemical recurrence (BCR) following radical prostatectomy (RP) or radiation therapy (RT), stratified by prostate-specific antigen doubling time (PSA-DT).
Retrospective, observational cohort study using the Optum® PC electronic medical record database (2012-2023). Patients with BCR were stratified into high-/low-risk groups based on PSA-DT of <12/≥12 months. A sensitivity analysis defined risk status using a ≤9-/>9-month cutoff.
The study included 2,981 patients with BCR in the RP cohort and 697 in the RT cohort. Median follow-up was 30.8 months (Q1-Q3: 18.1-50.8). Any treatment use was higher among high-risk BCR patients (RP: 67.1% vs 54.9%; RT: 52.8% vs 28.7%). After RP, most patients received salvage RT (high-risk: 41.3%; low-risk: 40.7%), followed by androgen-deprivation therapy (ADT) monotherapy (high-risk: 30.2%; low-risk: 22.8%) and ADT plus androgen receptor pathway inhibitor (ARPI) (high-risk: 11.9%; low-risk: 3.7%). After RT, ADT monotherapy (high-risk: 22.9%; low-risk: 12.3%) and ADT plus ARPI (high-risk: 16.5%; low-risk 4.9%) were most common. Sensitivity analyses showed similar results.
These findings demonstrate that ADT remains the predominant standard of care, whereas ADT plus ARPI is infrequently used, even among high-risk BCR patients.
How men are treated when their prostate cancer returns after initial therapyProstate cancer (PC) is the most common cancer diagnosed in men in the USA and was the second leading cause of death in 2023. Primary treatment options include radical prostatectomy and radiation therapy (RT); however, approximately 20–50% of patients will subsequently show rising prostate-specific antigen–a state known as biochemical recurrence (BCR). Patients with BCR tend to have high risk of morbidity and mortality, with many patients going on to develop metastasis. Therefore, it is important to monitor patients for BCR, identify their risk for disease progression, and tailor treatments to optimize outcomes. In this study, we examined medical record data from a large, nationally representative US database to examine real-world treatment patterns in patients with PC who developed BCR after primary therapy. The findings of our analysis suggest that many patients with BCR are not being treated–even those considered at high risk for disease progression. Of the patients who were treated, most received salvage RT or androgen-deprivation therapy alone. Patients and caregivers should discuss available treatment options and weigh individual risks and benefits at the first sign of BCR in PC. The use of androgen-deprivation therapy combined with a second-generation androgen receptor inhibitor is infrequently selected for patients with high-risk BCR.
Future oncology (London, England). 2026 Apr 29 [Epub ahead of print]
Rana R McKay, Nasreen Khan, Neal D Shore, Guifang Chen, Vlasta Hlebec, Shankar Srinivasan, Daniel E Spratt
Department of Medical Oncology, University of California, San Diego, CA, USA., Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA., Department of Urology, START Carolinas Research Center, Myrtle Beach, SC, USA., Bayer Consumer Care AG, Basel, Switzerland., University Hospitals Seidman Cancer Center, Cleveland, OH, USA.