The risk that keeps giving.

Not all biochemical recurrences are created equal. A biochemical recurrence of initially higher risk disease confers 4x the risk of prostate cancer death than recurrence of lower risk disease. With that in mind, here’s a nice description of outcomes of nearly 1000 biochemical recurrences following definitive external beam radiation with (n=324) or without (n=654) brachytherapy for high-risk prostate cancer. At a median follow-up of almost 4 years after biochemical recurrence, 435 men (44%) had distant metastases, well over half of which developed within one year. At 5 years, the rate of distant mets was 50% after EBRT alone versus 34% when brachytherapy was included, and prostate cancer death was 27-29%, supporting previously noted trends. Unsurprisingly, development of mets and prostate cancer death occurred faster with shorter intervals to first biochemical recurrence. | Philipson, Eur Urol 2021