{"entity":{"id":"radiographic-progression-free-survival","kind":"term","name":"Radiographic progression-free survival (rPFS)","aka":["rPFS","radiographic progression free survival","radiologic progression-free survival","imaging-based progression-free survival","rPFS by PCWG"],"tldr":"In cancer that has already spread, this is the time until the scans show it getting worse, or the man dies. It deliberately ignores a rising PSA on its own, because in prostate cancer the PSA can rise for reasons that do not mean the treatment has stopped working.","summary":"Radiographic progression-free survival is the time from randomisation to the first documented progression on imaging, or death from any cause, whichever comes first, with prostate-specific antigen rise alone explicitly excluded as an event. It is the workhorse endpoint of metastatic castration-resistant prostate cancer trials, and the reason it exists is the Prostate Cancer Clinical Trials Working Group's judgement that biochemical progression is an unreliable proxy in a disease where androgen receptor-directed drugs can move the PSA independently of tumour burden.\n\nThe imaging rules come from PCWG2 and are carried forward by PCWG3. Soft-tissue disease is assessed by RECIST. Bone disease is assessed on bone scan, where progression requires a minimum of two new lesions; PCWG2 advises against a follow-up bone scan before 12 weeks of treatment unless clinically indicated, because of the flare phenomenon, in which a responding bone metastasis looks worse before it looks better; and confirmation requires a further scan performed six or more weeks later showing additional new lesions. That is the rule usually shorthanded as two plus two. PCWG3 added time to symptomatic skeletal events and the concept of no longer clinically benefiting, to separate the first evidence of progression from the clinical need to change treatment, and asked that progression in existing lesions be documented separately from the appearance of new ones.\n\nAs with metastasis-free survival, the operational definition is set by each protocol, and three things vary: the imaging schedule, whether the reads are by investigator or by blinded independent central review, and whether bone-scan progression alone is enough. That is why reported medians are not interchangeable. COU-AA-302 reported radiographic progression-free survival of 16.5 months with abiraterone and prednisone against 8.3 months with prednisone alone in 1,088 chemotherapy-naive men (hazard ratio 0.53; 95 percent confidence interval 0.45 to 0.62). TRITON3 reported imaging-based progression-free survival of 11.2 against 6.4 months in its BRCA subgroup. Both are radiographic progression endpoints; neither was measured the same way.","asOf":"2026-09-25","links":[{"label":"Scher et al., Journal of Clinical Oncology 2008 (PCWG2): design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone","url":"https://doi.org/10.1200/jco.2007.12.4487"},{"label":"Scher et al., Journal of Clinical Oncology 2016 (PCWG3): trial design and objectives for castration-resistant prostate cancer, updated recommendations","url":"https://doi.org/10.1200/jco.2015.64.2702"}],"tags":["gu","prostate-glossary"],"related":["metastasis-free-survival","psa50","vision","profound","hazard-ratio","bone-metastases"],"cancers":["prostate","prostate-mcrpc","prostate-mhspc","prostate-nepc"],"sections":["hormonal","imaging","targeted-therapy"],"technologies":["psma-pet","pet"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["metastasis-free-survival","psa50","psa","hazard-ratio","castration-resistance","bone-metastases"],"trials":[],"people":[],"bottlenecks":["b-trial-design","b-regulatory-fragmentation","b-resistance"],"keyPapers":["paper-abiraterone-acetate-prostate-n-engl-j-med-2013","paper-fizazi-triton3-rucaparib-nejm-2023","paper-antonarakis-ar-v7-resistance-nejm-2014"],"journals":[],"dependsOn":[],"notes":["The flare rule, and why an early scan can mislead. A bone metastasis that is responding to treatment can increase osteoblastic activity and light up more brightly on a bone scan before it improves. PCWG2's answer is not to scan before 12 weeks unless there is a clinical reason, and to require a confirmatory scan six or more weeks after the first one showing additional new lesions before calling progression. A single alarming scan at week six is, under these rules, not an event.","Why the PSA is left out. A rising prostate-specific antigen is the most visible thing that happens to a man on treatment and the most misleading. PCWG2 recommends that early changes in PSA or pain not be acted on without other evidence of progression, and that treatment continue for at least 12 weeks to ensure adequate drug exposure. Radiographic progression-free survival encodes that judgement in the endpoint itself."],"category":"Endpoints"},"route":"/terms/radiographic-progression-free-survival/","neighbours":{"term":[{"id":"bone-metastases","kind":"term","name":"Bone metastases and skeletal-related events","route":"/terms/bone-metastases/"},{"id":"castration-resistance","kind":"term","name":"Castration-resistant prostate cancer (CRPC)","route":"/terms/castration-resistance/"},{"id":"hazard-ratio","kind":"term","name":"Hazard ratio (HR)","route":"/terms/hazard-ratio/"},{"id":"metastasis-free-survival","kind":"term","name":"Metastasis-free survival (MFS)","route":"/terms/metastasis-free-survival/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"psa50","kind":"term","name":"PSA50 / PSA90 response","route":"/terms/psa50/"}],"trial":[{"id":"profound","kind":"trial","name":"PROfound","route":"/trials/profound/"},{"id":"vision","kind":"trial","name":"VISION","route":"/trials/vision/"}],"cancer":[{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"},{"id":"prostate-mhspc","kind":"cancer","name":"Metastatic hormone-sensitive prostate cancer","route":"/cancers/prostate-mhspc/"},{"id":"prostate-nepc","kind":"cancer","name":"Neuroendocrine and small-cell prostate cancer","route":"/cancers/prostate-nepc/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"hormonal","kind":"section","name":"Hormonal Therapy","route":"/fronts/hormonal/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"},{"id":"targeted-therapy","kind":"section","name":"Targeted Therapy","route":"/fronts/targeted-therapy/"}],"technology":[{"id":"pet","kind":"technology","name":"PET (positron emission tomography)","route":"/technologies/pet/"},{"id":"psma-pet","kind":"technology","name":"PSMA PET","route":"/technologies/psma-pet/"}],"bottleneck":[{"id":"b-resistance","kind":"bottleneck","name":"Acquired resistance to every therapy","route":"/bottlenecks/b-resistance/"},{"id":"b-regulatory-fragmentation","kind":"bottleneck","name":"Regulatory divergence between regions","route":"/bottlenecks/b-regulatory-fragmentation/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"paper":[{"id":"paper-abiraterone-acetate-prostate-n-engl-j-med-2013","kind":"paper","name":"Abiraterone in metastatic prostate cancer without previous chemotherapy","route":"/key-papers/paper-abiraterone-acetate-prostate-n-engl-j-med-2013/"},{"id":"paper-scher-affirm-enzalutamide-nejm-2012","kind":"paper","name":"AFFIRM: increased survival with enzalutamide in prostate cancer after chemotherapy","route":"/key-papers/paper-scher-affirm-enzalutamide-nejm-2012/"},{"id":"paper-antonarakis-ar-v7-resistance-nejm-2014","kind":"paper","name":"AR-V7 and resistance to enzalutamide and abiraterone in prostate cancer","route":"/key-papers/paper-antonarakis-ar-v7-resistance-nejm-2014/"},{"id":"paper-beer-prevail-enzalutamide-nejm-2014","kind":"paper","name":"PREVAIL: enzalutamide in metastatic prostate cancer before chemotherapy","route":"/key-papers/paper-beer-prevail-enzalutamide-nejm-2014/"},{"id":"paper-denmeade-transformer-bipolar-androgen-therapy-jco-2021","kind":"paper","name":"TRANSFORMER: bipolar androgen therapy versus enzalutamide in asymptomatic metastatic castration-resistant prostate cancer","route":"/key-papers/paper-denmeade-transformer-bipolar-androgen-therapy-jco-2021/"},{"id":"paper-fizazi-triton3-rucaparib-nejm-2023","kind":"paper","name":"TRITON3: rucaparib or physician's choice in metastatic castration-resistant prostate cancer","route":"/key-papers/paper-fizazi-triton3-rucaparib-nejm-2023/"}],"idea":[{"id":"idea-prostate-randomise-the-sequence-not-only-the-drugs","kind":"idea","name":"Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer","route":"/ideas/idea-prostate-randomise-the-sequence-not-only-the-drugs/"}]}}