Prostate Cancer Treatment and Research
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The BRS is a pragmatic, robust, and easily calculable prognostic tool for mCRPC patients undergoing [177Lu]Lu-PSMA-617 therapy, successfully validated in an independent external cohort.
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PURPOSE: Lu]Lu-PSMA-617 is a standard-of-care therapy for metastatic castration-resistant prostate cancer (mCRPC). Given the heterogeneous clinical responses, accessible prognostic tools are needed. We recently demonstrated that the Bellmunt Risk Score (BRS)-comprising ECOG performance status >0, hemoglobin <10 g/dL, and the presence of liver metastases-predicts overall survival (OS) in a primary mCRPC cohort. This study aims to externally validate the BRS in an independent cohort. METHODS: Lu]Lu-PSMA-617 at an independent tertiary center. The BRS was calculated at baseline (range 0-3). Endpoints included OS analyzed via Kaplan-Meier estimators, multivariable Cox regression, Harrell's C-index, and time-dependent area under the curve (tAUC). RESULTS: The cohort was distributed into BRS 0 (17.6%), BRS 1 (52.7%), BRS 2 (26.1%), and BRS 3 (2.9%). Kaplan-Meier analysis revealed significant risk stratification, with an estimated median OS of 24.0, 15.8, 11.2, and 8.7 months for BRS 0, 1, 2, and 3, respectively (p < 0.001). In univariable analysis, BRS significantly predicted survival. In multivariable Cox regression adjusted for the number of prior treatment lines, BRS 2 (HR 3.04, p < 0.001) and BRS 3 (HR 4.76, p = 0.002) remained independent predictors of shortened OS. The BRS demonstrated robust predictive accuracy, achieving a tAUC of 71.3% for 1-year OS. CONCLUSION: Lu]Lu-PSMA-617 therapy, successfully validated in an independent external cohort.
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@article{Bttner2026External,
title = {External validation of the bellmunt risk score for survival prediction in mCRPC patients undergoing [177Lu]Lu-PSMA-617 therapy},
author = {Thomas Büttner and Mike Wenzel and Philipp Mandel and Paul Schmitt and Christian Hoffmann and Milka Marinova and Markus Essler and Felix K.‐H. Chun and Manuel Ritter and Daniel Groener and Philipp Krausewitz},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
doi = {10.1007/s00259-026-08169-7},
url = {https://doi.org/10.1007/s00259-026-08169-7}
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