AUA 2022: Impact of Disease Status Heterogeneity of the STAMPEDE Trial Arm J Population on Oncological Outcomes in High-Risk Nonmetastatic Prostate Cancer

(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on surgical therapy of localized prostate cancer and a presentation by Dr. Shingo Hatakeyama discussing the impact of disease status heterogeneity of the STAMPEDE trial arm J population on oncological outcomes in high-risk nonmetastatic prostate cancer. A recent clinical trial showed a novel risk model for nonmetastatic high-risk prostate cancer in the STAMPEDE trial arm J population including node-positive or >=2 of T3-4, PSA>= 40 ng/mL, and Gleason Score 8-10 disease. However, the impact of disease status heterogeneity of this population remains unclear. Dr. Hatakeyama and colleagues investigated the effect of disease status and treatment modality on prognosis in those patients.

 

This study investigated 382 patients with non-metastatic-high-risk prostate cancer treated with androgen deprivation therapy (ADT), ADT + radical prostatectomy, or ADT + radiation therapy between May 2004 and January 2021. Dr. Hatakeyama compared castration-resistant prostate cancer (CRPC)-free survival and overall survival between the organ-confined disease (T3N0) and non-organ-confined disease (T4 or N+). Risk factors for poor prognosis in this population were evaluated by a multivariable Cox regression analysis.

There were 255 and 127 patients in the organ-confined disease and non-organ-confined disease groups, respectively:

STAMPEDE Trial Arm J-0.jpg

CRPC-FS and overall survival were significantly different between the groups, as highlighted in the following Kaplan Meier curves:

STAMPEDE Trial Arm J-1.jpg

Multivariate Cox regression analysis showed T4 and local therapy were significantly associated with CRPC-FS (T4 - HR 2.68, 95% CI 1.74-4.13; local therapy – HR 0.18, 95% CI 0.11-0.31) and overall survival (T4 - HR 2.39, 95% CI 1.21-4.69; local therapy – HR 0.24, 95% CI 0.11-0.52). However, CRPC-FS and overall survival were not significantly different between the patients with T4N0 and TanyN+ in the non-organ-confined disease group.

Dr. Hatakeyama concluded his presentation discussing the impact of disease status heterogeneity of the STAMPEDE trial arm J population on oncological outcomes in high-risk nonmetastatic prostate cancer with the following concluding points:

  • There was meaningful heterogeneity of background for outcome in the STAMPEDE trial arm J population
  • The effect of local therapy on prognosis was significant in patients with non-metastatic-high-risk prostate cancer

Presented by: Shingo Hatakeyama, MD, Hirosaki University School of Medicine, Hirosaki, Japan

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

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