Raisa S Pompe1,2,3, Derya Tilki1,3, Felix Preisser1,2, Sami-Ramzi Leyh-Bannurah1,2,3, Marco Bandini2,4, Michele Marchioni2,5, Philipp Gild3, Zhe Tian2, Nicola Fossati4, Luca Cindolo6, Shahrokh F Shariat7, Hartwig Huland1, Markus Graefen1, Alberto Briganti4, Pierre I Karakiewicz2. 1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 3. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy. 6. Department of Urology, ASL Abruzzo 2, Chieti, Italy. 7. Department of Urology Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: To test whether local treatment (LT), namely radical prostatectomy (RP) or brachytherapy (BT) still confers a survival benefit versus no local treatment (NLT), when adjusted for baseline PSA (bPSA). To further examine whether the effect of LT might be modulated according to bPSA and M1 substages. METHODS: Of 13 906 mPCa patients within the SEER (2004-2014), 375 underwent RP, 175 BT, and 13 356 NLT. Multivariable competing risks regression (MVA CRR) analyses after 1:2 propensity score matching assessed the impact of LT versus NLT on cancer specific mortality (CSM). Interaction analyses tested the association between treatment type and bPSA within different M1 substages. RESULTS: MVA CRR analyses revealed lower CSM rates for LT (RP [HR: 0.55, CI: 0.44-0.70, P < 0.001] and BT [HR: 0.63, CI: 0.49-0.83, P < 0.001]) compared to NLT. A significant interaction existed between bPSA and treatment type, in M1b patients only. Here, LT conferred a survival benefit when bPSA was <60 ng/mL with maximum benefit when bPSA was <40 ng/mL. No survival benefit existed for M1b patients above the 60 ng/mL bPSA threshold and for M1c patients, regardless of bPSA. For M1a patients, LT conferred a survival benefit compared to NLT. However, dose-response according to bPSA could not be tested, due to insufficient sample size. CONCLUSIONS: Our observations provide new insight regarding the pivotal effect of bPSA and M1 substages on CSM, when LT is contemplated. While M1a patients benefited from LT, the survival benefit was modulated by bPSA in M1b patients and no survival benefit existed in M1c patients.
BACKGROUND: To test whether local treatment (LT), namely radical prostatectomy (RP) or brachytherapy (BT) still confers a survival benefit versus no local treatment (NLT), when adjusted for baseline PSA (bPSA). To further examine whether the effect of LT might be modulated according to bPSA and M1 substages. METHODS: Of 13 906 mPCa patients within the SEER (2004-2014), 375 underwent RP, 175 BT, and 13 356 NLT. Multivariable competing risks regression (MVA CRR) analyses after 1:2 propensity score matching assessed the impact of LT versus NLT on cancer specific mortality (CSM). Interaction analyses tested the association between treatment type and bPSA within different M1 substages. RESULTS: MVA CRR analyses revealed lower CSM rates for LT (RP [HR: 0.55, CI: 0.44-0.70, P < 0.001] and BT [HR: 0.63, CI: 0.49-0.83, P < 0.001]) compared to NLT. A significant interaction existed between bPSA and treatment type, in M1b patients only. Here, LT conferred a survival benefit when bPSA was <60 ng/mL with maximum benefit when bPSA was <40 ng/mL. No survival benefit existed for M1b patients above the 60 ng/mL bPSA threshold and for M1c patients, regardless of bPSA. For M1a patients, LT conferred a survival benefit compared to NLT. However, dose-response according to bPSA could not be tested, due to insufficient sample size. CONCLUSIONS: Our observations provide new insight regarding the pivotal effect of bPSA and M1 substages on CSM, when LT is contemplated. While M1a patients benefited from LT, the survival benefit was modulated by bPSA in M1b patients and no survival benefit existed in M1c patients.
Authors: Gargi Kothari; Piet Ost; Patrick Cheung; Pierre Blanchard; Alison C Tree; Nicholas J van As; Simon S Lo; Drew Moghanaki; Andrew Loblaw; Shankar Siva Journal: Curr Oncol Rep Date: 2019-03-27 Impact factor: 5.075
Authors: Ann-Kathrin Oehus; Stephanie G C Kroeze; Nina-Sophie Schmidt-Hegemann; Marco M E Vogel; Simon Kirste; Jessica Becker; Irene A Burger; Thorsten Derlin; Peter Bartenstein; Matthias Eiber; Michael Mix; Christian la Fougère; Claus Belka; Stephanie E Combs; Anca-Ligia Grosu; Arndt-Christian Müller; Matthias Guckenberger; Hans Christiansen; Christoph Henkenberens Journal: BMC Cancer Date: 2020-04-29 Impact factor: 4.430
Authors: Christoph Henkenberens; Ann-Kathrin Oehus; Thorsten Derlin; Frank Bengel; Tobias L Ross; Markus A Kuczyk; Stefan Janssen; Hans Christiansen; Christoph A J von Klot Journal: Strahlenther Onkol Date: 2020-05-12 Impact factor: 3.621