Improvement in overall and cancer‐specific survival in contemporary, metastatic prostate cancer chemotherapy exposed patients

Abstract

Introduction 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. Materials and Methods 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. Results 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). Conclusions In mPCa patients, chemotherapy rates increased over time. A concomitant increase in survival was also recorded.

Non‐organ confined stage and upgrading rates in exclusive PSA high‐risk prostate cancer patients

“…The current SEER database samples the United States population and approximates it in demographic composition and cancer incidence 13 . Within SEER database 2010–2015, we identified all patients ≥18 years old with histologically confirmed adenocarcinoma of the prostate, diagnosed at biopsy (International Classification of Disease for Oncology [ICD‐O‐3] code 8140 site code C61.9), as previously reported 14 . We subsequently focused on cT1c‐stage patients (cN0/cM0) and GGG1, GGG2, or GGG3 at biopsy, who underwent RP.…”

“…13 Within SEER database 2010-2015, we identified all patients ≥18 years old with histologically confirmed adenocarcinoma of the prostate, diagnosed at biopsy (International Classification of Disease for Oncology [ICD-O-3] code 8140 site code C61.9), as previously reported. 14 We subsequently focused on cT1c-stage patients (cN0/cM0) and GGG1, GGG2, or GGG3 at biopsy, who underwent RP. Moreover, only patients with PSA >20 and ≤50 ng/ml at diagnosis were included in further analyses.…”

Effect of chemotherapy in metastatic prostate cancer according to race/ethnicity groups

“…Survival in metastatic prostate cancer (mPCa), irrespectively of promising new systemic therapies, remains low. [1][2][3][4][5][6] To the best of our knowledge, no large scale, sufficiently-powered, North-American study examined the effect of race/ethnicity on overall survival benefit from chemotherapy in de novo mPCa. 2,[7][8][9][10][11] The effect of race/ethnicity was examined in few post hoc analyses of prospective randomized trials.…”