AUA 2022: The Impact of Older Age on the Oncological Outcomes for High-Risk Metastatic Hormone-Sensitive Prostate Cancer Treated with Upfront Intensive Therapy

(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on advanced prostate cancer and a presentation by Dr. Shingo Hatakeyama discussing the impact of older age on the oncological outcomes for high-risk metastatic hormone-sensitive prostate cancer (mHSPC) treated with upfront intensive therapy. The impact of older age on the prognosis for high-risk mHSPC treated with upfront intensive therapy remains unclear. Dr. Hatakeyama and colleagues aimed to assess the impact of older age (75 years or older) on oncological outcomes in patients with CHAARTED1 high-volume mHSPC between patients with androgen deprivation therapy (ADT) plus upfront docetaxel or abiraterone acetate plus prednisolone and vintage therapy (ADT monotherapy or combined androgen blockade).


This multicenter retrospective study included 294 and 521 patients in the upfront group (docetaxel – 95 patients; abiraterone acetate plus prednisolone - 199 patients) and in the vintage group (ADT monotherapy), respectively. Among these 815 patients, they identified 304 patients aged 75 years or older. Dr. Hatakeyama compared castration-resistant prostate cancer-free survival (CRPC-FS) and overall survival (OS) between the upfront and vintage groups. Additionally, multivariable Cox regression analysis was performed to access the effect of upfront intensive therapy on prognosis in the older age population.

Among the 304 patients older than 75 years of age, there were 102 and 202 patients in the upfront group (docetaxel – 27 patients; abiraterone acetate plus prednisolone - 75 patients) and in the vintage group, respectively. In the older patients, the upfront group had significantly prolonged CRPC-FS and OS compared with the vintage group:

AUA_Hatakeyama-0.jpg

CRPC-FS was significantly longer in patients with upfront abiraterone acetate plus prednisolone therapy than those with upfront docetaxel therapy, but OS was not significantly different between the upfront abiraterone acetate plus prednisolone and docetaxel therapies:

AUA_Hatakeyama-1.jpg

Multivariable Cox regression analysis showed the upfront group had significantly prolonged CRPC-FS and OS.

Dr. Hatakeyama concluded this presentation by discussing the impact of older age on the oncological outcomes for high-risk mHSPC treated with upfront intensive therapy by stating that upfront intensive therapy significantly prolonged CRPC-FS and OS compared with the vintage therapy in this older population of real-world patients. 

Presented by: Shingo Hatakeyama, MD, Department of Urology, Hirosaki University Graduate 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. 

References:

  1. Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med. 2015;373(8):737-746.
email news signup