Real-world treatment patterns in patients with biochemical recurrence after local prostate cancer therapy

Describe real-world anticancer treatment patterns in the USA among patients with prostate cancer (PC) who experience biochemical recurrence (BCR) following radical prostatectomy (RP) or radiation therapy (RT), stratified by prostate-specific antigen doubling time (PSA-DT).

Retrospective, observational cohort study using the Optum® PC electronic medical record database (2012-2023). Patients with BCR were stratified into high-/low-risk groups based on PSA-DT of <12/≥12 months. A sensitivity analysis defined risk status using a ≤9-/>9-month cutoff.

The study included 2,981 patients with BCR in the RP cohort and 697 in the RT cohort. Median follow-up was 30.8 months (Q1-Q3: 18.1-50.8). Any treatment use was higher among high-risk BCR patients (RP: 67.1% vs 54.9%; RT: 52.8% vs 28.7%). After RP, most patients received salvage RT (high-risk: 41.3%; low-risk: 40.7%), followed by androgen-deprivation therapy (ADT) monotherapy (high-risk: 30.2%; low-risk: 22.8%) and ADT plus androgen receptor pathway inhibitor (ARPI) (high-risk: 11.9%; low-risk: 3.7%). After RT, ADT monotherapy (high-risk: 22.9%; low-risk: 12.3%) and ADT plus ARPI (high-risk: 16.5%; low-risk 4.9%) were most common. Sensitivity analyses showed similar results.

These findings demonstrate that ADT remains the predominant standard of care, whereas ADT plus ARPI is infrequently used, even among high-risk BCR patients.