We conducted a retrospective cross-sectional analysis from a single institution of dn (38 patients) versus pp (52 patients) metastatic patients looking at patient characteristics, gleason scores, duration of hormone sensitivity, and treatment. We have found that patients with dn metastatic disease compared to those pp presented with lower hemoglobin level and albumin level, signifying a sicker population, had a higher PSA on presentation and were more likely than the pp metastatic patients to metastasize to lymph nodes. Interestingly, Gleason scores from biopsy at time of diagnosis were similar for both groups at around 8, though perhaps just indicative of the nature of the malignancy to metastasize. Moreover, dn patients had a statistically significant lower duration of hormone sensitivity (median 372 days) compared to pp patients (median 1613 days). Although we have a small number of patients in the study, we attempted to calculate overall survival as measured from the date of diagnosis for men with dn and from the date of diagnosis of metastasis for those with pp. The median survival in the dn group was 6.2 years while that in pp was 11.6 years (p=0.03).
We believe our manuscript was the first to attempt a comparative description of differences between pp and dn metastatic prostate patients. We have shown that there are differences in characteristics, especially in duration of hormone sensitivity and possibly in survival, signifying a difference in tumor biology. This difference may also result in differential effects of various treatments used in metastatic prostate cancer patients if stratified to dn vs pp, raising the importance of possibly performing subset analysis by characterizing and subgrouping the patients in the GETUG-AFU-15, CHAARTED, STAMPEDE, and LATITUDE trials into dn versus pp. We also concluded that future trials may attempt to further characterize dn and pp patients into different stratification of groups rather than including all the populations together, as they have different biology.
Written by: Jeanny B. Aragon-Ching
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