Cancer-specific mortality outcomes in patients with biochemical recurrence after radical prostatectomy vs. radiation therapy: Report from a single tertiary referral center

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Eur Urol

Keywords

Urology & Nephrology

Abstract

Introduction & Objectives: Biochemical recurrence (BCR) is widely used to compare treatment modalities for prostate cancer, although its definition and PSA kinetics differ substantially between treatments. Prior studies suggested a variable impact of BCR on cancer-specific mortality (CSM) based on initial treatment modality. We aimed to evaluate BCR rates after radical prostatectomy (RP) vs radiation therapy (RT) and compare CSM outcomes in patient with BCR after one of these treatments. Materials & Methods: We included all patients with clinically localized prostate cancer (cT1–T3) who underwent initial RP or RT at Henry Ford Hospital (Detroit, MI, USA) between 1995 and 2023. BCR was defined as PSA ≥0.2 ng/mL on two consecutive measurements after RP, and PSA rise ≥2 ng/mL above nadir after RT. Patients with persistent PSA after RP were excluded. Cumulative incidence curves and Cox regression were used to evaluate the impact of initial treatment modality (RP vs RT) in patient with BCR on CSM, after adjusting to all available covariates. Results: In total 5057 patients were included, 3523 (70%) treated with RP vs 1534 (30%) with RT. Median (IQR) age at diagnosis was 62 (56- 67) years for RP vs. 71 (65-75) years for RT (p<0.001). Patients in the RT group presented with slightly higher clinical stage (cT2–3: 24.7% vs 20.7%, p=0.003), higher Gleason grade distribution (≥8: 10.6% vs 9.6%, p<0.001) and a greater proportion of clinically node-positive disease (cN1: 1.4% vs 0.1%, p<0.001). At 10-year, overall BCR rate was 71.9% vs 77.2% in patient treated with RP vs RT (p<0.001). Among patients with BCR, RT patients had EAU low-risk BCR more frequently than RP patients (75.0% vs 58.9%, p<0.001). Median (IQ) follow-up after BCR was 6.0 yrs (2.9–11.1). At 10-years from BCR, CSM rate 6.8% vs 24.6% in patient treated with RP vs RT (p<0.001). On multivariable analysis, treatment modality was an independent predictor of CSM in patients with BCR, where patient treated with RT had 5.15-fold higher CSM risk (95% CI 2.85–9.30, p<0.001) than their RP counterparts. Conclusions: BCR carries a markedly different prognostic meaning after RT compared to RP. The heterogeneity in BCR definitions and PSA kinetics across treatments limits the validity of BCR as a comparative endpoint, underscoring the need for treatment-specific interpretation in clinical decision-making.

Volume

89

First Page

1

Find It @ Sladen

Share

COinS