# Bellmunt Risk Score as a Prognostic Tool in Metastatic Castration-Resistant Prostate Cancer Survival

## TL;DR

The Bellmunt Risk Score helps predict survival in patients with advanced prostate cancer and can guide treatment decisions.

## Contribution

The Bellmunt Risk Score is validated as a robust and independent prognostic tool across different treatment settings for metastatic castration-resistant prostate cancer.

## Key findings

- Higher Bellmunt Risk Scores are consistently linked to worse overall survival in mCRPC patients.
- The score remains a strong independent predictor of survival in multivariable models.
- The BRS is practical for clinical use due to its simplicity and reliability.

## Abstract

Is the Bellmunt Risk Score (BRS) a valid prognostic tool for predicting survival in patients with metastatic castration-resistant prostate cancer (mCRPC)?

In this prognostic study using data for 1756 patients with mCRPC in the ACIS and ELM-PC-5 phase 3 trials, having a higher BRS was consistently associated with unfavorable overall survival and radiographic progression-free survival. The BRS remained a robust and independent prognostic factor for both outcomes in multivariable models.

These findings suggest that the BRS provides validated and clinically meaningful prognostic information that can aid in guiding treatment decisions and risk stratification in patients with mCRPC.

This prognostic study uses data from 2 randomized clinical trials to assess whether the Bellmunt Risk Score is a valid tool for predicting survival in patients with metastatic castration-resistant prostate cancer (mCRPC).

Metastatic castration-resistant prostate cancer (mCRPC) is an incurable disease with a highly variable clinical course, necessitating robust prognostic tools to guide individualized patient management.

To validate the prognostic ability of the Bellmunt Risk Score (BRS) for predicting survival in patients with mCRPC.

For this prognostic study, a post hoc analysis was conducted of 2 international, multicenter, phase 3 randomized clinical trials of men (aged ≥18 years) with mCRPC (ACIS [first-line setting] and ELM-PC-5 [postdocetaxel setting]). The ACIS trial enrolled patients between December 2014 and August 2016. The ELM-PC-5 trial enrolled patients between October 2010 and February 2013. Data analyses were conducted between September 2024 and March 2025.

Baseline BRS (range, 0-3), calculated by assigning 1 point for each of 3 factors (Eastern Cooperative Oncology Group Performance Status score ≥1, hemoglobin level <10 g/dL, and liver metastases).

The primary outcomes, overall survival (OS) and radiographic progression-free survival, were assessed via Kaplan-Meier and multivariable Cox proportional hazards regression analysis.

This analysis included 678 evaluable male participants from the ACIS trial (median age, 71 years [range, 48-92 years]) and 1078 from the ELM-PC-5 trial (median age, 70 years [range, 43-89 years]), for a total of 1756 participants. The median follow-up was 54.8 months (IQR, 51.5-58.4 months) in the ACIS trial and 10.7 months (IQR, 0.4-27.1 months) in the ELM-PC-5 trial. Having a higher BRS was consistently associated with unfavorable OS in both cohorts. In the ACIS trial, the median OS decreased from 42.2 months (95% CI, 35.7-46.7 months) for patients with a BRS of 0 to 9.1 months (95% CI, 3.7 months to not reached) for those with a BRS of 3. Adjusted hazard ratios (AHRs) for OS were 1.37 (95% CI, 1.12-1.67) for patients with a BRS of 1, 2.64 (95% CI, 1.89-3.69) for a BRS of 2, and 8.29 (95% CI, 2.57-26.78) for a BRS of 3 compared with those with a BRS of 0. In the ELM-PC-5 trial, the median OS decreased from 23.0 months (95% CI, 21.50 months to not reached) for patients with a BRS of 0 to 3.2 months (95% CI, 1.4-8.6 months) for those with a BRS of 3. AHRs for OS were 1.65 (95% CI, 1.31-2.07) for patients with a BRS of 1, 2.93 (95% CI, 2.22-3.87) for those with a BRS of 2, and 4.43 (95% CI, 2.65-7.40) for those with a BRS of 3 compared with those with a BRS of 0. The BRS remained a robust and independent prognostic factor for both outcomes in all multivariable models.

In this prognostic study of patients with mCRPC, the BRS was validated as a prognostic tool that provides clinically meaningful information across different treatment lines. Due to its simplicity, the BRS is a practical aid for guiding treatment decisions and facilitating prognostic discussions in routine clinical care.