Bellmunt Risk Score Predicts Survival in Metastatic Castration-Resistant Prostate Cancer: Study
Germany: A prognostic study published in JAMA Network Open suggests that the Bellmunt Risk Score (BRS) may help predict survival outcomes in patients with Metastatic Castration-Resistant Prostate Cancer (mCRPC). The analysis found that higher scores were consistently associated with poorer overall survival and faster disease progression, highlighting the score’s potential role in guiding treatment decisions.
Metastatic castration-resistant prostate cancer is an advanced stage of prostate cancer that progresses despite hormone therapy and remains largely incurable. Because patient outcomes can vary widely, reliable prognostic tools are essential for improving individualized treatment planning. The Bellmunt Risk Score is a simple clinical tool designed to categorize patients based on baseline risk factors.
The study was led by Thomas Büttner from the Department of Urology and Pediatric Urology at University Hospital Bonn in Bonn, Germany. Researchers conducted a post hoc analysis using data from two international phase 3 clinical trials involving men with mCRPC: the ACIS trial, which examined first-line treatment, and the ELM-PC-5 trial, which included patients who had previously received chemotherapy.
The combined analysis included 1,756 men with Metastatic Castration-Resistant Prostate Cancer, including 678 from the ACIS trial and 1,078 from the ELM-PC-5 trial, with a median age of about 70 years. Median follow-up was nearly 55 months in ACIS and around 11 months in ELM-PC-5.
The Bellmunt Risk Score (0–3) is based on three baseline factors: ECOG performance status ≥1, hemoglobin <10 g/dL, and presence of liver metastases, with each factor contributing one point.
Researchers assessed the association between baseline BRS and two outcomes: overall survival and radiographic progression-free survival.
The researchers reported the following findings:
- Higher Bellmunt Risk Score values were strongly associated with worse outcomes across both clinical trials involving patients with Metastatic Castration-Resistant Prostate Cancer.
- In the ACIS trial, median overall survival declined from about 42 months in patients with a BRS of 0 to approximately 9 months in those with a BRS of 3.
- In the ELM-PC-5 trial, median overall survival decreased from around 23 months for patients with a BRS of 0 to just over 3 months for those with a BRS of 3.
- Statistical analyses showed that the Bellmunt Risk Score remained an independent predictor of overall survival and radiographic progression-free survival after adjusting for other clinical factors.
- The prognostic value of the score was consistent across different treatment settings, including both first-line therapy and post-chemotherapy patients.
According to the researchers, the simplicity of the Bellmunt Risk Score makes it a practical tool for routine clinical care. It may help physicians stratify patients by risk, guide treatment choices, and support discussions about prognosis. The score may also assist in future clinical trials by enabling better patient stratification and identifying individuals who could benefit from more intensive therapies or experimental treatments.
Reference:
Büttner T, Klümper N, Ellinger J, Ritter M, Krausewitz P. Bellmunt Risk Score as a Prognostic Tool in Metastatic Castration-Resistant Prostate Cancer Survival. JAMA Netw Open. 2026;9(3):e260300. doi:10.1001/jamanetworkopen.2026.0300
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