Top Line: Biochemically recurrent (BCR) prostate cancer is a unique entity as it often happens with no evidence of gross disease.
The Study: Thus nailing down an appropriate definition has been an area of debate for decades with a goal of avoiding meaningful treatment delays while reducing unnecessary salvage therapies. A Swedish population-based cohort study supports recent data in demonstrating no clear association between BCR and PCSM following either radical prostatectomy (n=10,364) or definitive radiation (n=5947) for localized prostate cancer. At 15 years, the cumulative incidence of BCR after prostatectomy was 16% for low risk disease, 30% for intermediate risk, and 46% for high risk. After radiation those rates were 18%, 24%, and 36%. However, they went a step further and categorized BCRs according to the EAU criteria. After prostatectomy, a low-risk BCR is defined as a PSA doubling time >1 year and grade group <4. Those patients had a lower rate of PCSM than those with a high risk BCR (4% v 9%). After radiation, a low-risk BCR is defined as an interval >18 months to BCR and grade group <4. Likewise, those patients had a lower rate of PCSM than those with high risk BCR (24% v 46%). This difference in PCSM between modalities could in part be explained by a significantly higher proportion of men experiencing BCR after prostatectomy. The authors also acknowledge “differential selection introduces the possibility of confounding by indication, where underlying patient characteristics associated with treatment choice may influence the observed outcomes.”
TBL: Risk stratification of biochemical recurrences may help identify patients at higher risk of prostate cancer mortality and direct the intensity of salvage therapy. | Falagario, JAMA Netw Open 2023
The Study: Thus nailing down an appropriate definition has been an area of debate for decades with a goal of avoiding meaningful treatment delays while reducing unnecessary salvage therapies. A Swedish population-based cohort study supports recent data in demonstrating no clear association between BCR and PCSM following either radical prostatectomy (n=10,364) or definitive radiation (n=5947) for localized prostate cancer. At 15 years, the cumulative incidence of BCR after prostatectomy was 16% for low risk disease, 30% for intermediate risk, and 46% for high risk. After radiation those rates were 18%, 24%, and 36%. However, they went a step further and categorized BCRs according to the EAU criteria. After prostatectomy, a low-risk BCR is defined as a PSA doubling time >1 year and grade group <4. Those patients had a lower rate of PCSM than those with a high risk BCR (4% v 9%). After radiation, a low-risk BCR is defined as an interval >18 months to BCR and grade group <4. Likewise, those patients had a lower rate of PCSM than those with high risk BCR (24% v 46%). This difference in PCSM between modalities could in part be explained by a significantly higher proportion of men experiencing BCR after prostatectomy. The authors also acknowledge “differential selection introduces the possibility of confounding by indication, where underlying patient characteristics associated with treatment choice may influence the observed outcomes.”
TBL: Risk stratification of biochemical recurrences may help identify patients at higher risk of prostate cancer mortality and direct the intensity of salvage therapy. | Falagario, JAMA Netw Open 2023