Shintaro Narita1, Takahiro Kimura2, Shingo Hatakeyama3, Kenichi Hata2,4, Takafumi Yanagisawa2, Shinya Maita5, Shuji Chiba6, Hiromi Sato7, Soki Kashima7, Atsushi Koizumi7, Ryohei Yamamoto7, Koichiro Takayama8, Katsumi Okane9, Toshiya Ishida10, Yohei Horikawa11, Teruaki Kumazawa12, Jiro Shimoda5, Takehiro Suzuki13, Chikara Ohyama3, Shin Egawa2, Tomonori Habuchi7. 1. Department of Urology, Akita University School of Medicine, Akita, Japan. naritashintaro@gmail.com. 2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. 3. Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan. 4. Department of Urology, Atsugi City Hospital, Kanagawa, Japan. 5. Department of Urology, Iwate Prefectural Isawa Hospital, Mizusawa, Japan. 6. Department of Urology, Yuri Kumiai General Hospital, Honjo, Japan. 7. Department of Urology, Akita University School of Medicine, Akita, Japan. 8. Department of Urology, Yokote City Hospital, Yokote, Japan. 9. Department of Urology, Akita Kosei Medical Center, Akita, Japan. 10. Department of Urology, Akita City Hospital, Akita, Japan. 11. Department of Urology, Akita Red Cross Hospital, Akita, Japan. 12. Department of Urology, Omagari Kosei Medical Center, Daisen, Japan. 13. Department of Urology, Hiraka General Hospital, Yokote, Japan.
Abstract
PURPOSE: We assessed clinical outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with two upfront therapies. METHODS: The medical records of 301 patients with mCSPC treated with androgen deprivation therapy plus upfront abiraterone acetate (ABI) or docetaxel (DOC) between 2014 and 2021 were retrospectively reviewed. Propensity score matching (PSM) was performed to compare survival outcomes. Subgroup analyses of risk factors for second progression were conducted. RESULTS: A total of 95 patients received upfront DOC, whereas 206 received upfront ABI. After PSM, the ABI group had a significantly better castration-resistant prostate cancer (CRPC)-free survival than the DOC group [hazard ratio (HR), 0.53; 95% confidence interval (CI), 0.34-0.82]. Second progression-free survival (PFS2) tended to be longer in the ABI group than in the DOC group, but the difference was not statistically significant (HR, 0.64; 95% CI, 0.33-1.22). No significant difference in overall survival (OS) was found between the two groups (HR, 0.92; 95% CI, 0.42-2.03). In the subgroup analysis, upfront ABI had significantly favorable PFS2 in patients aged ≥ 75 years compared with upfront DOC (p = 0.038). Four risk factors for second progression (primary Gleason 5, liver metastasis, high serum alkaline phosphatase level, and high serum lactate dehydrogenase level) successfully stratified patients into three risk groups. CONCLUSIONS: Upfront ABI provided better CRPC-free survival than upfront DOC; however, no significant differences in PFS2 or OS were observed between the two groups. Personalized management based on prognostic risk factors may benefit patients with mCSPC treated with upfront intensified therapies.
PURPOSE: We assessed clinical outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with two upfront therapies. METHODS: The medical records of 301 patients with mCSPC treated with androgen deprivation therapy plus upfront abiraterone acetate (ABI) or docetaxel (DOC) between 2014 and 2021 were retrospectively reviewed. Propensity score matching (PSM) was performed to compare survival outcomes. Subgroup analyses of risk factors for second progression were conducted. RESULTS: A total of 95 patients received upfront DOC, whereas 206 received upfront ABI. After PSM, the ABI group had a significantly better castration-resistant prostate cancer (CRPC)-free survival than the DOC group [hazard ratio (HR), 0.53; 95% confidence interval (CI), 0.34-0.82]. Second progression-free survival (PFS2) tended to be longer in the ABI group than in the DOC group, but the difference was not statistically significant (HR, 0.64; 95% CI, 0.33-1.22). No significant difference in overall survival (OS) was found between the two groups (HR, 0.92; 95% CI, 0.42-2.03). In the subgroup analysis, upfront ABI had significantly favorable PFS2 in patients aged ≥ 75 years compared with upfront DOC (p = 0.038). Four risk factors for second progression (primary Gleason 5, liver metastasis, high serum alkaline phosphatase level, and high serum lactate dehydrogenase level) successfully stratified patients into three risk groups. CONCLUSIONS: Upfront ABI provided better CRPC-free survival than upfront DOC; however, no significant differences in PFS2 or OS were observed between the two groups. Personalized management based on prognostic risk factors may benefit patients with mCSPC treated with upfront intensified therapies.
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