As currently defined, biochemical recurrence (BCR) following surgery or radiation treatment for prostate cancer is not a reliable predictor of the risk of dying from the disease, investigators concluded based on the findings of a large population-based study.

The study also demonstrated that the risk of prostate cancer death among patients with low-risk BCR, as defined by the European Association of Urology (EAU), is much higher among radiation therapy recipients compared with those treated with radical prostatectomy, “indicating the need for more stringent criteria.”

Among 16,311 Swedish men with prostate cancer, 10,364 underwent radical prostatectomy (mean age 64) and 5947 received radiation therapy (mean age 69). In the radical prostatectomy cohort, the 15-year cumulative incidences of BCR were 16%, 30%, and 46% for the D’Amico low-, intermediate-, and high-risk groups, respectively. In the radiation therapy cohort, the 15-year cumulative incidences of BCR were 18%, 24%, and 36% for the D’Amico low-, intermediate-, and high-risk groups, respectively.

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Cumulative prostate cancer-specific mortality over 10 years was 4% and 9% after radical prostatectomy for the patients who developed low- and high-risk BCR, respectively, according to criteria from the European Association of Urology (EAU), Ugo Giovanni Falagario, MD, of the University of Foggia in Italy, and colleagues reported in JAMA Network Open. After radiation therapy, the 10-year prostate cancer-specific mortality rates were 24% and 46%, respectively – much higher than in the surgery group partly due to the radiation group’s older age and worse overall health, according to the investigators.

Dr Falagario’s team concluded that “while the risk of dying from prostate cancer in low-risk EAU-BCR after radical prostatectomy was very low, patients who developed low-risk EAU-BCR after radiotherapy had a nonnegligible risk of prostate cancer mortality. Improving risk stratification of patients with BCR is pivotal to guide salvage treatment decisions, reduce overtreatment, and limit the number of staging tests in the event of PSA elevations after primary treatment.”

Patients with low-risk BCR after radical prostatectomy might consider undergoing immediate salvage treatment, they noted.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Falagario UG, Abbadi A, Remmers S, et al. Biochemical recurrence and risk of mortality following radiotherapy or radical prostatectomy. JAMA Netw Open. Published online September 12, 2023. doi:10.1001/jamanetworkopen.2023.32900