Identifying patients at highest risk of cancer-specific mortality in this cohort of patients may help better risk stratify receipt of these treatment options, especially as there is some suggestion that chemotherapy may be preferred for more aggressive disease.
Utilizing the SEER database from the United States, the authors identified all men with metastatic prostate cancer, specifically focusing on men with bone metastases at the time of diagnosis, between 2010 and 2013. Of the 220,000 men with prostate cancer during this time frame, 8,040 men had bone metastases at the time of diagnosis.
On further analysis, they identified 2,497 men (31.1%) who died of disease (prostate cancer specific mortality [PCSM]) and 5,543 men (68.9%) without PCSM (n=643 dead of other causes; n=4900 alive) over a median follow-up of 35 months (interquartile range [IQR] 34‒37). Patients with PCSM were more likely to be older, unmarried, have had biopsy Gleason Group (bGG) 5 disease or no prostate biopsy, and had concomitant PCa brain, liver, and lung metastases at diagnosis compared to patients without PCSM.
On competing risks modelling, older age (HR 1.023), non-black/white race (HR 0.77), unmarried status (HR 1.10), higher prostate-specific antigen (PSA) (HR 1.005), bGG 4 (HR 1.53), bGG 5 (HR 2.18), no prostate biopsy (HR 2.97), and concomitant brain (HR 1.48), liver (HR 2.18), and lung metastases at diagnosis (HR 1.33) as predictive of PCSM.
An obvious limitation of the study is median follow-up of approximately 3 years. However, as this represents a relative aggressive pathology cohort, it likely captures a significant portion of the PCSM.
Based on these results, while the entire cohort represents an aggressive pathology with high PCSM risk in the first 3 years, specifically men with prostate bGG 4‒5 disease presenting with bone and concomitant visceral metastasis should be considered for early, aggressive systemic therapy and/or clinical trials.
Presented By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Co-Authors: Thenappan Chandrasekar, Hanan Goldberg, Robert J. Hamilton, Neil E. Fleshner, Girish S. Kulkarni
Institution: University of Toronto
Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto Twitter: @tchandra_uromd at the 72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada
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