Over the last decade, multiple clinical trials demonstrated improved survival after chemotherapy for metastatic prostate cancer (mPCa). However, real-world data validating this effect within large-scale epidemiological data sets are scarce. We addressed this void.
Men with de novo mPCa were identified and systemic chemotherapy status was ascertained within the Surveillance, Epidemiology, and End Results database (2004-2016). Patients were divided between historical (2004-2013) versus contemporary (2014-2016). Chemotherapy rates were plotted over time. Kaplan-Meier plots and Cox regression models with additional multivariable adjustments addressed overall and cancer-specific mortality. All tests were repeated in propensity-matched analyses.
Overall, 19,913 patients had de novo mPCa between 2004 and 2016. Of those, 1838 patients received chemotherapy. Of 1838 chemotherapy-exposed patients, 903 were historical, whereas 905 were contemporary. Chemotherapy rates increased from 5% to 25% over time. Median overall survival was not reached in contemporary patients versus was 24 months in historical patients (hazard ratio [HR]: 0.55, p < 0.001). After propensity score matching and additional multivariable adjustment (age, prostate-specific antigen, GGG, cT-stage, cN-stage, cM-stage, and local treatment) a HR of 0.55 (p < 0.001) was recorded. Analyses were repeated for cancer-specific mortality after adjustment for other cause mortality in competing risks regression models and recorded virtually the same findings before and after propensity score matching (HR: 0.55, p < 0.001).
In mPCa patients, chemotherapy rates increased over time. A concomitant increase in survival was also recorded.
The Prostate. 2021 Sep 15 [Epub ahead of print]
Benedikt Hoeh, Christoph Würnschimmel, Rocco S Flammia, Benedikt Horlemann, Gabriele Sorce, Francesco Chierigo, Zhe Tian, Fred Saad, Markus Graefen, Michele Gallucci, Alberto Briganti, Carlo Terrone, Shahrokh F Shariat, Derya Tilki, Luis A Kluth, Philipp Mandel, Felix K H Chun, Pierre I Karakiewicz
Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza Rome University, Rome, Italy., Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.