Stephen H Culp1, Paul F Schellhammer2, Michael B Williams2. 1. Department of Urology, University of Virginia, Charlottesville, VA, USA. Electronic address: shc5e@virginia.edu. 2. Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA.
Abstract
BACKGROUND: Few data exist regarding the impact on survival of definitive treatment of the prostate in men diagnosed with metastatic prostate cancer (mPCa). OBJECTIVE: To evaluate the survival of men diagnosed with mPCa based on definitive treatment of the prostate. DESIGN, SETTING, AND PARTICIPANTS: Men with documented stage IV (M1a-c) PCa at diagnosis identified using Surveillance Epidemiology and End Results (SEER) (2004-2010) and divided based on definitive treatment of the prostate (radical prostatectomy [RP] or brachytherapy [BT]) or no surgery or radiation therapy (NSR). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Kaplan-Meier methods were used to calculate overall survival (OS). Multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and identify factors associated with cause-specific mortality (CSM). RESULTS AND LIMITATIONS: A total of 8185 patients were identified: NSR (n=7811), RP (n=245), and BT (n=129). The 5-yr OS and predicted DSS were each significantly higher in patients undergoing RP (67.4% and 75.8%, respectively) or BT (52.6 and 61.3%, respectively) compared with NSR patients (22.5% and 48.7%, respectively) (p<0.001). Undergoing RP or BT was each independently associated with decreased CSM (p<0.01). Similar results were noted regardless of the American Joint Committee on Cancer (AJCC) M stage. Factors associated with increased CSM in patients undergoing local therapy included AJCC T4 stage, high-grade disease, prostate-specific antigen ≥20 ng/ml, age ≥70 yr, and pelvic lymphadenopathy (p<0.05). The major limitation of this study was the lack of variables from SEER known to influence survival of patients with mPCa, including treatment with systemic therapy. CONCLUSIONS: Definitive treatment of the prostate in men diagnosed with mPCa suggests a survival benefit in this large population-based study. These results should serve as a foundation for future prospective trials. PATIENT SUMMARY: We used a large population-based cancer database to examine survival in men diagnosed with metastatic prostate cancer (mPCa) undergoing definitive therapy for the prostate. Local therapy (LT) appeared to confer a survival benefit. Therefore, we conclude that prospective trials are needed to further evaluate the role of LT in mPCa.
BACKGROUND: Few data exist regarding the impact on survival of definitive treatment of the prostate in men diagnosed with metastatic prostate cancer (mPCa). OBJECTIVE: To evaluate the survival of men diagnosed with mPCa based on definitive treatment of the prostate. DESIGN, SETTING, AND PARTICIPANTS: Men with documented stage IV (M1a-c) PCa at diagnosis identified using Surveillance Epidemiology and End Results (SEER) (2004-2010) and divided based on definitive treatment of the prostate (radical prostatectomy [RP] or brachytherapy [BT]) or no surgery or radiation therapy (NSR). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Kaplan-Meier methods were used to calculate overall survival (OS). Multivariable competing risks regression analysis was used to calculate disease-specific survival (DSS) probability and identify factors associated with cause-specific mortality (CSM). RESULTS AND LIMITATIONS: A total of 8185 patients were identified: NSR (n=7811), RP (n=245), and BT (n=129). The 5-yr OS and predicted DSS were each significantly higher in patients undergoing RP (67.4% and 75.8%, respectively) or BT (52.6 and 61.3%, respectively) compared with NSR patients (22.5% and 48.7%, respectively) (p<0.001). Undergoing RP or BT was each independently associated with decreased CSM (p<0.01). Similar results were noted regardless of the American Joint Committee on Cancer (AJCC) M stage. Factors associated with increased CSM in patients undergoing local therapy included AJCC T4 stage, high-grade disease, prostate-specific antigen ≥20 ng/ml, age ≥70 yr, and pelvic lymphadenopathy (p<0.05). The major limitation of this study was the lack of variables from SEER known to influence survival of patients with mPCa, including treatment with systemic therapy. CONCLUSIONS: Definitive treatment of the prostate in men diagnosed with mPCa suggests a survival benefit in this large population-based study. These results should serve as a foundation for future prospective trials. PATIENT SUMMARY: We used a large population-based cancer database to examine survival in men diagnosed with metastatic prostate cancer (mPCa) undergoing definitive therapy for the prostate. Local therapy (LT) appeared to confer a survival benefit. Therefore, we conclude that prospective trials are needed to further evaluate the role of LT in mPCa.
Authors: Andrea K Miyahira; Joshua M Lang; Robert B Den; Isla P Garraway; Tamara L Lotan; Ashley E Ross; Tanya Stoyanova; Steve Y Cho; Jonathan W Simons; Kenneth J Pienta; Howard R Soule Journal: Prostate Date: 2015-10-19 Impact factor: 4.104
Authors: Joseph R Zabell; Oluwakayode Adejoro; Stephanie L Jarosek; Sean P Elliott; Badrinath R Konety Journal: World J Urol Date: 2016-02-25 Impact factor: 4.226
Authors: L Tosco; A Laenen; A Briganti; P Gontero; R J Karnes; M Albersen; P J Bastian; P Chlosta; F Claessens; F K Chun; W Everaerts; C Gratzke; M Graefen; B Kneitz; G Marchioro; R S Salas; B Tombal; T Van den Broeck; L Moris; A Battaglia; H van der Poel; J Walz; A Bossi; G De Meerleer; K Haustermans; H Van Poppel; M Spahn; S Joniau Journal: Prostate Cancer Prostatic Dis Date: 2017-05-09 Impact factor: 5.554