Real-World Treatment Patterns in Patients With Biochemical Recurrence After Local Therapy for Prostate Cancer: Retrospective Analysis of a Large US Database

OBJECTIVES: Following radical prostatectomy (RP) or radiation therapy (RT) for prostate cancer (PC), patients variably develop biochemical recurrence (BCR), defined as rising prostate-specific antigen (PSA). Here we describe real-world (RW) treatment patterns in patients with BCR by risk status, defined by PSA doubling time (PSADT).

METHODS: This retrospective cohort study used nationally representative Optum^© electronic medical records (7/2012–9/2022) to identify adults with PC who developed BCR (PSA ≥0.2 ng/mL after RP; PSA ≥“nadir + 2 ng/mL” after RT) and had ≥6 months of follow-up data after BCR. PSADT <12 vs ≥12 months defined high- or low-risk BCR, respectively; a 9-month cutoff was used in a sensitivity analysis.

RESULTS: Overall, 3588 patients met criteria for BCR; 29%/41% had high-/low-risk BCR (30% had missing PSADT or undetermined risk status). Median (range) age at BCR was 67 (37–88) years; 83%/14% were White/Black; median (Q1–Q3) follow-up was 31 (18–51) months. Treatment post-BCR was received by 60% with high-risk vs 53% with low-risk BCR. After RP (n=2891), subsequent RT (high-risk, 41%; low-risk, 41%), androgen-deprivation therapy (ADT) monotherapy (high-risk, 30%; low-risk, 23%) and ADT + androgen receptor pathway inhibitor ([ARPI], including enzalutamide, apalutamide, darolutamide, or abiraterone, or 1^st generation ARI bicalutamide: high-risk, 18%; low-risk, 7%) were commonly used. After RT (n=697), ADT monotherapy (high-risk, 23%; low-risk, 12%) and ADT + ARPI (high-risk, 18%; low-risk 8%) were commonly used. Bicalutamide was the most common 1^st generation ARI or ARPI in both cohorts. The sensitivity analysis showed similar results.

CONCLUSIONS: Many patients with high-risk BCR did not receive treatment for BCR; of those who did, subsequent RT or ADT monotherapy were most common, followed by ADT + ARPI. Patients and caregivers should discuss available treatment options and weigh individual risks and benefits at first sign of BCR in PC.