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Renal & Urology NewsBCR Endpoints an Unreliable Surrogate for Survival in Prostate Cancer Trials

Investigators find a weak patient-level correlation between overall survival and biochemical recurrence (BCR)-free survival and time to BCR.

In a recent study published in the Journal of Clinical Oncology, researchers argue that biochemical recurrence (BCR) should not be the primary end point in randomized trials for localized prostate cancer. Although treatments that lower BCR risk do show promise, they do not necessarily correlate with improved overall survival rates, challenging the conventional wisdom in prostate cancer treatment strategies.

HCN Medical Memo
This study serves as a cautionary tale against relying solely on BCR-based end points for evaluating treatment efficacy. The findings emphasize the need for a more comprehensive approach that includes overall survival rates, particularly when considering treatment intensification and patient counseling.

Key Points:
  • The study, led by Amar U. Kishan, MD, of the University of California, Los Angeles, pooled data from 11 trials involving 10,741 patients.
  • Treatments like radiation dose escalation, short-term androgen deprivation therapy (ADT), and prolonging ADT reduced BCR risk by 29%, 47%, and 46%, respectively.
  • Only short- and long-term ADT significantly improved overall survival by 9% and 14%.
  • BCR at 48 months was linked to increased mortality risk, but after adjusting for this, no significant treatment effect on overall survival was observed.
  • Physicians’ Perspectives: The study challenges the current reliance on BCR as a primary end point, urging clinicians to consider overall survival as a more accurate measure.

According to the American Cancer Society, approximately one-third of men who undergo treatment for prostate cancer experience biochemical recurrence within 10 years.

Additional Points:
  • The patient-level correlation between overall survival and BCR-free survival ranged from 0.59 to 0.69, which is considered low.
  • The study acknowledged limitations like varying definitions of BCR and the evolution of prostate cancer imaging technologies.
  • The researchers suggest that metastasis-free survival could be a more appropriate end point for future clinical trials.

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