Incidence, Patterns, and Predictive Factors of Biochemical Failure Following Definitive Radiotherapy for Localized Prostate Cancer: A Retrospective Military Cohort Study.
Definitive radiotherapy represents a cornerstone treatment for localized prostate cancer, offering curative potential comparable to surgery. However, biochemical failure remains a concern, signaling possible disease progression.
This study aimed to evaluate the frequency, timing, and predictors of biochemical failure in patients receiving definitive radiotherapy for localized prostate cancer at a military oncology center.
We conducted a retrospective cohort study of 91 patients with localized or locally advanced prostate cancer (cT1-T3, N0-1, M0) treated with definitive radiotherapy at the Military Cancer Center in Jordan between 2020 and 2025. Biochemical failure was defined using the Phoenix criteria (prostate-specific antigen (PSA) nadir + 2 ng/mL). Biochemical recurrence-free survival was estimated using Kaplan-Meier analysis, and independent predictors of biochemical failure were identified using Cox proportional hazards regression.
The median age was 70 years, and the median pre-treatment PSA was 18.0 ng/mL. According to National Comprehensive Cancer Network (NCCN) risk stratification, 62/91 (68.1%) had high/very high-risk disease, 25/91 (27.5%) had intermediate-risk disease, and 4/91 (4.4%) had low-risk disease. Over a median follow-up of 36 months, 22 patients (24.2%) experienced biochemical failure, with a median time to failure of 24 months. The two-year and five-year biochemical recurrence-free survival rates were 84.6% and 70.3%, respectively. Multivariable analysis identified pre-treatment PSA greater than 20 ng/mL (hazard ratio (HR): 2.8; 95% confidence interval (CI): 1.4-5.6; p = 0.004) and PSA nadir greater than 0.1 ng/mL (HR: 3.2; 95% CI: 1.6-6.4; p = 0.001) as the strongest independent predictors of biochemical failure. Patients with PSA nadir > 0.1 ng/mL had a 3.2-fold higher hazard of biochemical failure compared to those with PSA nadir ≤ 0.1 ng/mL.
Definitive radiotherapy provides favorable biochemical control in this military cohort, with outcomes comparable to international benchmarks. Pre-treatment PSA and post-treatment PSA nadir independently predict biochemical failure, supporting their role in risk stratification and individualized follow-up planning. However, these findings require prospective validation in larger, multicenter cohorts before individualized surveillance strategies can be widely implemented.
This study aimed to evaluate the frequency, timing, and predictors of biochemical failure in patients receiving definitive radiotherapy for localized prostate cancer at a military oncology center.
We conducted a retrospective cohort study of 91 patients with localized or locally advanced prostate cancer (cT1-T3, N0-1, M0) treated with definitive radiotherapy at the Military Cancer Center in Jordan between 2020 and 2025. Biochemical failure was defined using the Phoenix criteria (prostate-specific antigen (PSA) nadir + 2 ng/mL). Biochemical recurrence-free survival was estimated using Kaplan-Meier analysis, and independent predictors of biochemical failure were identified using Cox proportional hazards regression.
The median age was 70 years, and the median pre-treatment PSA was 18.0 ng/mL. According to National Comprehensive Cancer Network (NCCN) risk stratification, 62/91 (68.1%) had high/very high-risk disease, 25/91 (27.5%) had intermediate-risk disease, and 4/91 (4.4%) had low-risk disease. Over a median follow-up of 36 months, 22 patients (24.2%) experienced biochemical failure, with a median time to failure of 24 months. The two-year and five-year biochemical recurrence-free survival rates were 84.6% and 70.3%, respectively. Multivariable analysis identified pre-treatment PSA greater than 20 ng/mL (hazard ratio (HR): 2.8; 95% confidence interval (CI): 1.4-5.6; p = 0.004) and PSA nadir greater than 0.1 ng/mL (HR: 3.2; 95% CI: 1.6-6.4; p = 0.001) as the strongest independent predictors of biochemical failure. Patients with PSA nadir > 0.1 ng/mL had a 3.2-fold higher hazard of biochemical failure compared to those with PSA nadir ≤ 0.1 ng/mL.
Definitive radiotherapy provides favorable biochemical control in this military cohort, with outcomes comparable to international benchmarks. Pre-treatment PSA and post-treatment PSA nadir independently predict biochemical failure, supporting their role in risk stratification and individualized follow-up planning. However, these findings require prospective validation in larger, multicenter cohorts before individualized surveillance strategies can be widely implemented.
Authors
Alnajada Alnajada, Ghnmein Ghnmein, Ayyad Ayyad, Abukaff Abukaff, Bani Essa Bani Essa, Alhabahbeh Alhabahbeh, Daheerat Daheerat, Alzyoud Alzyoud, Alhiary Alhiary
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