{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:35:55Z","timestamp":1790613355797,"version":"4.1.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To validate the prognostic ability of the Bellmunt Risk Score (BRS) for predicting survival in patients with mCRPC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n For this prognostic study, a post hoc analysis was conducted of 2 international, multicenter, phase 3 randomized clinical trials of men (aged \u226518 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.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Baseline BRS (range, 0-3), calculated by assigning 1 point for each of 3 factors (Eastern Cooperative Oncology Group Performance Status score \u22651, hemoglobin level &amp;lt;10 g\/dL, and liver metastases).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes, overall survival (OS) and radiographic progression-free survival, were assessed via Kaplan-Meier and multivariable Cox proportional hazards regression analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0300","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T16:30:27Z","timestamp":1772814627000},"page":"e260300","source":"Crossref","is-referenced-by-count":1,"title":["Bellmunt Risk Score as a Prognostic Tool in Metastatic Castration-Resistant Prostate Cancer Survival"],"prefix":"10.1001","volume":"9","author":[{"given":"Thomas","family":"B\u00fcttner","sequence":"first","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Kl\u00fcmper","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, 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