(UroToday.com) The 2022 American Urological Association (AUA) Annual Meeting included a session on advanced prostate cancer and a presentation by Dr. Isaac Kim discussing an association between the use of second-generation antiandrogens and overall survival in patients with metastatic prostate cancer. Dr. Kim’s previous study found a marginal survival improvement among patients diagnosed with metastatic prostate cancer in the second-generation antiandrogen era.1 When stratified by stage, only men with bone and visceral metastasis (M1b and M1c) experienced a statistically significant improvement in survival. In this study, Dr. Kim and colleagues tested the hypothesis that use of second-generation antiandrogens is associated with selective survival among M1b and M1c patients only.
The study was composed of patients with newly diagnosed metastatic prostate cancer identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Linked Database. The primary outcome was overall survival. Patients were classified to the pre- second-generation antiandrogen era if diagnosed in 2004-2010 and post-second-generation antiandrogen era if diagnosed in 2011-2016. Dr. Kim analyzed the association between use of second-generation antiandrogen and overall survival by the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.
This study included 7,791 patients, with a median age of 76.7 years. The median overall survival improved by 2 months from 27.2 to 29.4 months in M1b patients (p=0.01) but did not significantly change in M1a and M1c patients (p=0.99 and p=0.77, respectively);
Use of second-generation antiandrogens was uniformly distributed across M1a, M1b, and M1c patients (p=0.52):
In the post-second-generation antiandrogen era, second-generation antiandrogen use was significantly associated with increased overall survival among M1b patients only (HR 0.78; 95% CI 0.68-0.89) but not M1a and M1c patients (p=0.20 and p=0.32, respectively). Similar findings were found when assessing prostate cancer-specific survival:
Dr. Kim concluded his presentation by discussing an association between the use of second-generation antiandrogens and overall survival in patients with metastatic prostate cancer with the following take-home messages:
- Since the advent of second-generation antiandrogens in 2011, there has been a marginal overall survival improvement in patients with metastatic prostate cancer
- Survival improvements from second-generation antiandrogens were observed in M1b patients only
- Beyond these population-level analyses, further investigation is warranted
Presented by: Isaac Kim Jr., Brown University, Providence, RI
Co-Authors: Nikita Nikita, Joshua Banks, Scott Keith, Philadelphia, PA; Isaac Kim, New Haven, CT; Grace Lu-Yao, Philadelphia, PA
Written Bb: 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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