Impact of prior local therapy on overall survival in men with metastatic castration‐resistant prostate cancer: Results from Shared Equal Access Regional Cancer Hospital

Abstract

Objectives: To evaluate the impact of previous local treatment on survival in men with newly diagnosed metastatic castration-resistant prostate cancer (mCRPC). Methods: We performed a retrospective study of patients newly diagnosed with mCRPC in the year 2000 or later from eight Veterans Affairs Medical Centers. Patients were categorized based on prior local therapy (none, prostatectomy ± radiation or radiation alone). Overall and cancer specific survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to test the association between prior local treatment and survival. Results: Of 729 patients, 284 (39%) underwent no local treatment, 176 (24%) underwent radical prostatectomy ± radiation and 269 (37%) underwent radiation alone. On multivariable analysis, men with prior prostatectomy had improved overall (HR, 0.71; p=0.005) and cancer specific survival (HR, 0.55; p<0.001) compared to men with no prior local therapy. This improvement in overall (HR, 0.89; p=0.219) and cancer specific survival (HR, 0.87; p=0.170) was not seen in men with prior radiation alone. After further adjusting for comorbidity with Charlson Comorbidity Index, patients with prior prostatectomy still had improved overall survival (HR, 0.70; p=0.003) while this was not seen in patients who received prior radiation alone (HR, 0.88, p=0.185). Conclusions: Independent of patient and disease related factors, men with mCRPC who had undergone prior radical prostatectomy have improved overall and cancer-specific survival compared to those with no prior local therapy.

Predictors of skeletal‐related events and mortality in men with metastatic, castration‐resistant prostate cancer: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database

“…Of the 837 men within the current study cohort, 328 men (39%) did not receive primary localized therapy but immediately initiated systemic therapy. However, it is important to note that immediate hormonal therapy often is the treatment choice for patients with advanced asymptomatic disease who do not pursue local therapy . As such, to the best of our knowledge, the issue of whether local treatment truly impacts the natural progress of the disease or is merely a marker of men who had lower‐volume disease is unknown.…”

Response to Editorial Comment to Impact of prior local therapy on overall survival in men with metastatic castration‐resistant prostate cancer: Results from Shared Equal Access Regional Cancer Hospital

“…We thank Poelaert et al . for their comment on our manuscript . We wholeheartedly agree that our study is limited to selection bias in the context of its retrospective design.…”

Impact of Radiotherapy on Prognosis in Patients Diagnosed with Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

“…After the exclusion of 1,073 duplicate articles, 8,538 records were excluded based on the titles or abstracts for various reasons (reviews, letters, case reports, or unrelated to mPCa or unrelated to RT). After reading the remaining 20 articles in full text, 13 articles were excluded because 2 studies focused on the effect of prior LT on mPCa [15,16], 2 studies focused on the effect of LT on mPCa [7,8], 4 studies of repeated research [17][18][19][20], 3 repeated data studies [21][22][23], and 2 papers did not provide adequate data [24,25]. Finally, 7 studies [26][27][28][29][30][31][32] contributed to the systematic review and meta-analysis (Fig.…”