Biochemical recurrence (BCR) after primary definitive treatment for prostate cancer (PCa) is a heterogeneous disease state. While BCR is associated with worse oncologic outcomes, risk factors that impact outcomes can vary significantly, necessitating avenues for risk stratification. We sought to identify prognostic risk factors at the time of recurrence after primary radical prostatectomy or radiotherapy, and prior to salvage treatment(s), associated with adverse oncologic outcomes. We performed a systematic review of prospective studies in EMBASE, MEDLINE, and ClinicalTrials.gov (from January 1, 2000 to October 16, 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42023466330). We reviewed the factors associated with oncologic outcomes among patients with BCR after primary definitive treatment. A total of 37 studies were included (total = 10 632), 25 after prostatectomy (total = 9010) and 12 after radiotherapy (total = 1622). Following recurrence after prostatectomy, factors associated with adverse outcomes include higher pathologic T stage and grade group, negative surgical margins, shorter prostate-specific antigen doubling time (PSADT), higher prostate-specific antigen (PSA) prior to salvage treatment, shorter time to recurrence, the 22-gene tumor RNA signature, and recurrence location on molecular imaging. After recurrence following radiotherapy, factors associated with adverse outcomes include a shorter time to recurrence, and shorter PSADT or higher PSA velocity. Grade group, T stage, and prior short-term hormone therapy (4–6 mo) were not clearly associated with adverse outcomes, although sample size and follow-up were generally limited compared with postprostatectomy data. This work highlights the recommendations and level of evidence for risk stratifying patients with PCa recurrence, and can be used as a benchmark for personalizing salvage treatment based on prognostics.

中文翻译：

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前列腺癌初次治疗后复发患者的风险分层：系统评价


前列腺癌 (PCa) 初次彻底治疗后的生化复发 (BCR) 是一种异质性疾病状态。虽然 BCR 与较差的肿瘤结果相关，但影响结果的风险因素可能存在很大差异，因此需要进行风险分层。我们试图确定初次根治性前列腺切除术或放疗后以及挽救治疗前复发时与不良肿瘤学结果相关的预后危险因素。我们根据系统评价和荟萃分析指南的首选报告项目 (CRD42023466330) 对 EMBASE、MEDLINE 和 ClinicalTrials.gov 中的前瞻性研究（2000 年 1 月 1 日至 2023 年 10 月 16 日）进行了系统评价。我们回顾了初步确定性治疗后与 BCR 患者肿瘤学结局相关的因素。总共纳入 37 项研究（总计 = 10 632），其中 25 项是前列腺切除术后研究（总计 = 9010），12 项是放疗后研究（总计 = 1622）。前列腺切除术后复发后，与不良结果相关的因素包括较高的病理 T 分期和分级组、阴性手术切缘、较短的前列腺特异性抗原倍增时间 (PSADT)、挽救治疗前较高的前列腺特异性抗原 (PSA)、较短的治疗时间复发、22 基因肿瘤 RNA 特征以及分子成像上的复发位置。放疗后复发后，与不良结果相关的因素包括更短的复发时间、更短的 PSADT 或更高的 PSA 速度。尽管样本量和随访数据与前列腺切除术后数据相比通常有限，但分级组、T 分期和既往短期激素治疗（4-6 个月）与不良结果没有明显关联。 这项工作强调了对 PCa 复发患者进行风险分层的建议和证据水平，并且可以用作基于预后的个性化挽救治疗的基准。