Risk Stratification of Patients with Recurrence After Primary Treatment for Prostate Cancer: A Systematic Review

Area of Science:

• Oncology
• Urology
• Medical Informatics

Background:

• Biochemical recurrence (BCR) after prostate cancer (PCa) treatment is heterogeneous.
• Risk stratification is needed to guide salvage therapy decisions.
• Prognostic factors for adverse outcomes post-recurrence require identification.

Purpose of the Study:

• To identify prognostic risk factors for adverse oncologic outcomes in PCa patients experiencing BCR.
• To stratify risk prior to initiating salvage treatment after radical prostatectomy or radiotherapy.

Main Methods:

• Systematic review of prospective studies (2000-2023) from EMBASE, MEDLINE, and ClinicalTrials.gov.
• Analysis of factors associated with oncologic outcomes in patients with BCR.
• Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Main Results:

• Post-prostatectomy BCR: Higher pathologic T stage/grade, negative margins, shorter PSA doubling time (PSADT), higher PSA, shorter recurrence time, 22-gene signature, and imaging recurrence location predict adverse outcomes.
• Post-radiotherapy BCR: Shorter time to recurrence and shorter PSADT or higher PSA velocity are associated with adverse outcomes.
• Limited evidence for Grade group, T stage, and short-term hormone therapy in post-radiotherapy BCR.

Conclusions:

• This review provides evidence for risk stratifying PCa recurrence.
• Identified prognostic factors can personalize salvage treatment strategies.
• Establishes a benchmark for guiding clinical decisions in recurrent prostate cancer.