We assessed the proportion of patients with biochemical recurrence (BCR), the occurrence of BCR in risk groups according to prostate-specific antigen doubling time (PSA-DT), and clinical outcomes in risk groups.
Retrospective observational study of patients with non-metastatic prostate cancer (PC) (n = 26,755) in the US using the Optum® PC electronic medical record database. Primary outcomes were the proportion of patients with BCR in prior radical prostatectomy (RP) or radiation therapy (RT) cohorts. Secondary outcomes included association between baseline characteristics and time to BCR, BCR risk group (high-risk: PSA-DT <12 months; low-risk: PSA-DT ≥12 months), and time from BCR to metastasis and castration-resistant PC (CRPC).
BCR occurred in 19.7% of patients after RP and 8.8% after RT. Among high-risk BCR patients (n = 523) in the RP cohort, 19.3% developed metastasis, 14.5% developed CRPC, and 14.1% died. In contrast, among low-risk BCR patients (n = 1,356), rates were 10.2%, 7.0%, and 6.6%, respectively. In the RT cohort, 25.9% of the high-risk BCR patients (n = 498) developed metastasis, 21.5% developed CRPC, and 19.7% died, compared with 16.4%, 9.0%, and 16.4% among low-risk patients (n = 122), respectively.
PSA and PSA-DT are key predictors of BCR. Outcomes are worse among high-risk BCR patients with short PSA-DT.
This study looked at medical records from men who were treated for early-stage prostate cancer with surgery or radiation therapy. After treatment, some men showed a rise in their PSA levels in blood tests. This rise can be a sign that some cancer cells may still be present. We found that about 15 in every 100 men experience a rise in PSA levels after treatment, most often within 2 years. We also found that both the PSA level and how quickly it increases over time are important. A faster rise in PSA levels was linked to a higher chance of the cancer coming back and to poorer outcomes. Measuring how quickly PSA levels double over time can help doctors choose the most appropriate treatment to slow down or prevent the cancer from getting worse.
Future oncology (London, England). 2026 Apr 29 [Epub ahead of print]
Neal D Shore, Nasreen Khan, Rana R McKay, Niculae Constantinovici, Guifang Chen, Vlasta Hlebec, Shankar Srinivasan, Zdravko Vassilev, Daniel E Spratt
Atlantic Urology Clinics, START Carolinas/Carolina Urologic Research Center, Myrtle Beach, SC, USA., Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA., Division of Hematology-Oncology, Department of Internal Medicine, University of California San Diego, La Jolla, CA, USA., Bayer Consumer Care AG, Basel, Switzerland., Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.