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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
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Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy
Ugo Giovanni Falagario1,2, Ahmad Abbadi3, Sebastiaan Remmers4
1Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden.
JAMA Network Open
|September 11, 2023
Summary
Risk stratification of biochemical recurrence (BCR) after prostate cancer treatment is crucial. While the European Association of Urology (EAU) system is valid, low-risk BCR after radiotherapy carries a notable mortality risk, necessitating improved stratification for treatment decisions.
Area of Science:
- Oncology
- Urology
- Clinical Epidemiology
Background:
- Accurate risk stratification of patients with biochemical recurrence (BCR) after prostate cancer primary treatment is essential for guiding subsequent management.
- The European Association of Urology (EAU) provides criteria for stratifying BCR risk, but its association with prostate cancer-specific mortality (PCSM) requires further evaluation.
Purpose of the Study:
- To assess the association between BCR after radical prostatectomy or radiotherapy and PCSM.
- To evaluate the effectiveness of the current EAU risk stratification system in predicting PCSM.
Main Methods:
- A population-based cohort study of 16,311 male patients treated with radical prostatectomy or radiotherapy for localized prostate cancer (cT1-3, cM0) in Stockholm, Sweden (2003-2019).
- Patients with BCR were stratified into low- and high-risk groups based on EAU criteria.
- Cumulative incidences of BCR and PCSM were analyzed using long-term follow-up data.
Main Results:
- Following radical prostatectomy, 15-year BCR cumulative incidences were 16% (low-risk), 30% (intermediate-risk), and 46% (high-risk D'Amico groups).
- Following radiotherapy, 15-year BCR cumulative incidences were 18% (low-risk), 24% (intermediate-risk), and 36% (high-risk).
- The 10-year cumulative incidences of PCSM after radical prostatectomy were 4% (low-risk EAU-BCR) and 9% (high-risk EAU-BCR). After radiotherapy, 10-year PCSM cumulative incidences were 24% (low-risk EAU-BCR) and 46% (high-risk EAU-BCR).
Conclusions:
- The EAU BCR stratification system demonstrates validity in assessing PCSM risk.
- While low-risk EAU-BCR after radical prostatectomy has a very low PCSM risk, low-risk EAU-BCR after radiotherapy is associated with a non-negligible mortality risk.
- Improved risk stratification for BCR is crucial for optimizing salvage treatment decisions, reducing overtreatment, and minimizing unnecessary staging tests.
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