Devin N Patel1, Shalini Jha2,3, Lauren E Howard2,3, Christopher L Amling4, William J Aronson5,6, Matthew R Cooperberg7, Christopher J Kane8, Martha K Terris9,10, Brian F Chapin11, Stephen J Freedland1,3. 1. Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 2. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA. 3. Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA. 4. Division of Urology, Department of Urology, Oregon Health and Science University, Portland, Oregon, USA. 5. Department of Urology, Los Angeles School of Medicine, University of California, Los Angeles, California, USA. 6. Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles, Los Angeles, California, USA. 7. Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA. 8. Urology Department, University of California San Diego Health System, San Diego, California, USA. 9. Section of Urology, Veterans Affairs Medical Center, Augusta, Georgia, USA. 10. Section of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA. 11. Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Abstract
OBJECTIVES: To evaluate the impact of previous local treatment on survival in men with newly diagnosed metastatic castration-resistant prostate cancer. METHODS: We carried out a retrospective study of patients newly diagnosed with metastatic castration-resistant prostate cancer in the year 2000 or later from eight Veterans Affairs Medical Centers. Patients were categorized based on prior local therapy (none, prostatectomy ± radiation or radiation alone). Overall and cancer-specific survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to test the association between prior local treatment and survival. RESULTS: Of 729 patients, 284 (39%) underwent no local treatment, 176 (24%) underwent radical prostatectomy ± radiation and 269 (37%) underwent radiation alone. On multivariable analysis, men with prior prostatectomy had improved overall (hazard ratio 0.71, P = 0.005) and cancer-specific survival (hazard ratio 0.55, P < 0.001) compared with men with no prior local therapy. This improvement in overall (hazard ratio 0.89, P = 0.219) and cancer-specific survival (hazard ratio 0.87, P = 0.170) was not seen in men with prior radiation alone. After further adjusting for comorbidity with the Charlson Comorbidity Index, patients with prior prostatectomy still had improved overall survival (hazard ratio 0.70, P = 0.003), whereas this was not seen in patients who received prior radiation alone (hazard ratio 0.88, P = 0.185). CONCLUSIONS: Independent of patient- and disease-related factors, men with metastatic castration-resistant prostate cancer who had undergone prior radical prostatectomy have improved overall and cancer-specific survival compared with those with no prior local therapy.
OBJECTIVES: To evaluate the impact of previous local treatment on survival in men with newly diagnosed metastatic castration-resistant prostate cancer. METHODS: We carried out a retrospective study of patients newly diagnosed with metastatic castration-resistant prostate cancer in the year 2000 or later from eight Veterans Affairs Medical Centers. Patients were categorized based on prior local therapy (none, prostatectomy ± radiation or radiation alone). Overall and cancer-specific survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to test the association between prior local treatment and survival. RESULTS: Of 729 patients, 284 (39%) underwent no local treatment, 176 (24%) underwent radical prostatectomy ± radiation and 269 (37%) underwent radiation alone. On multivariable analysis, men with prior prostatectomy had improved overall (hazard ratio 0.71, P = 0.005) and cancer-specific survival (hazard ratio 0.55, P < 0.001) compared with men with no prior local therapy. This improvement in overall (hazard ratio 0.89, P = 0.219) and cancer-specific survival (hazard ratio 0.87, P = 0.170) was not seen in men with prior radiation alone. After further adjusting for comorbidity with the Charlson Comorbidity Index, patients with prior prostatectomy still had improved overall survival (hazard ratio 0.70, P = 0.003), whereas this was not seen in patients who received prior radiation alone (hazard ratio 0.88, P = 0.185). CONCLUSIONS: Independent of patient- and disease-related factors, men with metastatic castration-resistant prostate cancer who had undergone prior radical prostatectomy have improved overall and cancer-specific survival compared with those with no prior local therapy.
Authors: Christopher E Bayne; Stephen B Williams; Matthew R Cooperberg; Martin E Gleave; Markus Graefen; Francesco Montorsi; Giacomo Novara; Marc C Smaldone; Prasanna Sooriakumaran; Peter N Wiklund; Brian F Chapin Journal: Eur Urol Date: 2015-05-21 Impact factor: 20.096
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Authors: M A Eisenberger; B A Blumenstein; E D Crawford; G Miller; D G McLeod; P J Loehrer; G Wilding; K Sears; D J Culkin; I M Thompson; A J Bueschen; B A Lowe Journal: N Engl J Med Date: 1998-10-08 Impact factor: 91.245
Authors: Ingrid Lorese Tablazon; Lauren E Howard; Amanda M De Hoedt; William J Aronson; Christopher J Kane; Christopher L Amling; Matthew R Cooperberg; Martha K Terris; Stephen J Freedland; Stephen B Williams Journal: Cancer Date: 2019-08-07 Impact factor: 6.860