THE BELLMUNT RISK SCORE (BRS) has been validated as a robust prognostic tool for patients with metastatic castration-resistant prostate cancer (mCRPC), according to a large analysis of phase 3 clinical trial data.
mCRPC remains an incurable disease with a highly variable clinical course, creating a need for simple and reliable tools to guide treatment decisions and patient counselling. In this study, Büttner and colleagues evaluated the prognostic performance of the BRS using post hoc data from two international, multicentre phase 3 trials: ACIS (first-line setting) and ELM-PC-5 (post-docetaxel setting).
The analysis included 1,756 men with mCRPC. The BRS, which ranges from 0 to 3, assigns one point each for Eastern Cooperative Oncology Group performance status ≥1, haemoglobin <10 g/dL, and presence of liver metastases.
Higher Bellmunt Scores Linked to Poorer Survival
Across both trials, higher BRS scores were consistently associated with significantly worse overall survival (OS) and radiographic progression-free survival. In the ACIS cohort, median OS declined sharply from 42.2 months in patients with a BRS of 0 to just 9.1 months in those with a score of 3. Similarly, in the ELM-PC-5 cohort, median OS fell from 23.0 months to 3.2 months across the same score range.
Adjusted analyses confirmed the strength of this association. In ACIS, patients with a BRS of 3 had more than eight times the risk of death compared with those scoring 0. Comparable trends were observed in the ELM-PC-5 cohort, with progressively increasing hazard ratios seen at higher scores.
Tool May Support Clinical Decision-Making
Importantly, the BRS remained an independent prognostic factor across all multivariable models, regardless of treatment setting. This consistency across both first-line and later-line therapy highlights its broad clinical applicability.
The findings support the BRS as a simple, practical tool that can be readily implemented in routine care. By enabling clinicians to stratify patients according to risk, the score may help guide treatment selection, inform prognosis, and support shared decision-making.
Overall, this study provides strong validation of the BRS as a clinically meaningful prognostic instrument in mCRPC, addressing an important gap in personalised cancer care.
Reference
Büttner T et al. Bellmunt Risk Score as a Prognostic Tool in Metastatic Castration-Resistant Prostate Cancer Survival. JAMA Netw Open. 2026;9;(3):e260300
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