Abstract
Background and objective: 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. Methods: 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. Key findings and limitations: 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. Conclusions and clinical implications: 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 200-210 |
| Number of pages | 11 |
| Journal | European urology |
| Volume | 86 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2024 |
Funding
Funding/Support and role of the sponsor: Adam B. Weiner is supported by the Simon-Strauss Foundation, the UCLA Dr. Allen and Charlotte Ginsburg Fellowship in Precision Genomic Medicine, and the Prostate Cancer Foundation Young Investigator Award. Alison C. Tree is supported by a Cancer Research UK Radiation Research Centre of Excellence at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust (grant ref: A28724) and a Cancer Research UK Programme Grant (ref: C33589/A28284); and acknowledges NHS funding to the NIHR Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research. Daniel E. Spratt is supported by the University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care. The funders had no role in the design or conduct of the study.
Keywords
- Abiraterone
- Androgen deprivation therapy
- Apalutamide
- Biochemical recurrence
- Docetaxel
- Enzalutamide
- Hormone therapy
- Prostatic neoplasms
- Systematic review
- Therapeutics
ASJC Scopus subject areas
- Urology
