Discussion
SECONDARY
In this study, we examined a cohort of males who experienced PSA failure after ADT and RT with or without docetaxel for nonmetastatic unfavorable-risk PC in the context of a randomized clinical trial. We found 3 significant factors that were associated with a shorter time to PSA failure were being younger than 70 years, having a PSA of 10 ng/mL or more, and having a biopsy Gleason score of 8 to 10. By using these 3 factors, we defined a high-risk group with a 43.8% risk of PSA failure at 3 years. Of note, similar to a previously published randomized clinical trial,Time to PSA failure was investigated in other retrospective and secondary analyses of males who received RT alone or RT with ADT. In these studies, a shorter time to PSA failure associated with PC-specific mortality,Combination therapy of ADT and AR-signaling inhibitors leading to greater androgen suppression has been shown to improve clinical outcomes in males with nonmetastatic castrate-resistant PC (nmCRPC). The addition of enzalutamide to ADT was found to prolong OS in males with nmCRPC,Although the addition of docetaxel to ADT is currently not recommended for males with unfavorable-risk PC due to inconclusive results from previous randomized clinical trials,The use of molecular markers in risk stratification for PC is an active area of research with significant future potential. New tissue-based genomic tests, such as the Decipher, Prolaris, PTEN/TMPRSS2:ERG, Oncotype DX, ConfirmMDx, and ProMark, are being investigated to improve the detection and risk assessment of PC.