ArticleThe Prostate2026
Evaluating Risk Factors Associating With Late Recurrence After Low-Dose-Rate Brachytherapy for Prostate Cancer Using Machine Learning.
Article in The Prostate, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe Phoenix definition is widely used to define biochemical recurrence (BCR) after radiation therapy for prostate cancer; however, a definitive definition of cure remains unclear. This study aimed to identify factors associated with late BCR after low-dose-rate brachytherapy (LDR-BT), defined as BCR occurring ≥ 5 years after treatment among patients who remained recurrence-free during the first 5 years, using machine-learning methods.
methodsWe retrospectively analyzed 1419 patients who underwent LDR-BT between 2004 and 2019. Of these, 52 (3.7%) experienced BCR within 5 years, and 244 patients did not have ≥ 5 years of follow-up because of death or loss to follow-up. The remaining 1123 patients were recurrence-free at 5 years and formed the analysis cohort for late BCR (≥ 5 years). Random survival forest (RSF) and survival decision-tree analyses were applied to identify predictive factors, and recurrence-free survival was estimated using the Kaplan-Meier method.
resultsThe 10-year BCR-free survival rate was 94.8%. RSF identified the 5-year prostate-specific antigen (PSA) value, PSA doubling time (PSA-DT) at 5 years, primary Gleason pattern, and NCCN risk classification as the most important predictors. Optimal cutoff values were 0.93 ng/mL for PSA at 5 years and 5.3 years for PSA-DT. Patients with lower PSA or longer PSA-DT had significantly higher 10-year recurrence-free rates than those at higher risk (97.3% vs. 11.1% and 99.0% vs. 68.1%, respectively; p < 0.001).
conclusionsPSA level and PSA-DT at 5 years were strong predictors of late BCR after LDR-BT. These findings suggest that follow-up intervals may be safely extended for low-risk patients, thereby reducing the burden of hospital visits and healthcare costs.
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