Effect on Overall Survival of Locoregional Treatment in a Cohort of De Novo Metastatic Prostate Cancer Patients: A Single Institution Retrospective Analysis From the Royal Marsden Hospital.
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Authors
Bianchini, D
Lorente, D
Rescigno, P
Zafeiriou, Z
Psychopaida, E
O'Sullivan, H
Alaras, M
Kolinsky, M
Sumanasuriya, S
Sousa Fontes, M
Mateo, J
Perez Lopez, R
Tunariu, N
Fotiadis, N
Kumar, P
Tree, A
Van As, N
Khoo, V
Parker, C
Eeles, R
Thompson, A
Dearnaley, D
de Bono, JS
Lorente, D
Rescigno, P
Zafeiriou, Z
Psychopaida, E
O'Sullivan, H
Alaras, M
Kolinsky, M
Sumanasuriya, S
Sousa Fontes, M
Mateo, J
Perez Lopez, R
Tunariu, N
Fotiadis, N
Kumar, P
Tree, A
Van As, N
Khoo, V
Parker, C
Eeles, R
Thompson, A
Dearnaley, D
de Bono, JS
Document Type
Journal Article
Date
2017-10-01
Date Accepted
2017-04-14
Abstract
BACKGROUND: The optimal management of the primary tumor in metastatic at diagnosis (M1) prostate cancer (PCa) patients is not yet established. We retrospectively evaluated the effect of locoregional treatment (LRT) on overall survival (OS) hypothesizing that this could improve outcome through better local disease control and the induction of an antitumor immune response (abscopal effect). PATIENTS AND METHODS: M1 at diagnosis PCa patients referred to the Prostate Targeted Therapy Group at the Royal Marsden between June 2003 and December 2013 were identified. LRT was defined as either surgery, radiotherapy (RT) or transurethral prostatectomy (TURP) administered to the primary tumor at any time point from diagnosis to death. Kaplan-Meier analyses generated OS data. The association between LRT and OS was evaluated in univariate (UV) and multivariate (MV) Cox regression models. RESULTS: Overall 300 patients were identified; 192 patients (64%) experienced local symptoms at some point during their disease course; 72 patients received LRT (56.9% TURP, 52.7% RT). None of the patients were treated with prostatectomy. LRT was more frequently performed in patients with low volume disease (35.4% vs. 16.2%; P < .001), lower prostate-specific antigen (PSA) level at diagnosis (median PSA: 75 vs. 184 ng/mL; P = .005) and local symptoms (34.2% vs. 4.8%; P < .001). LRT was associated in UV and MV analysis with longer OS (62.1 vs. 55.8 months; hazard ratio [HR], 0.74; P = .044), which remained significant for RT (69.4 vs. 55.1 months; HR, 0.54; P = .002) but not for TURP. RT was associated with better OS independent of disease volume at diagnosis. CONCLUSION: These data support the conduct of randomized phase III trials to evaluate the benefit of local control in patients with M1 disease at diagnosis.
Citation
Clinical genitourinary cancer, 2017, 15 (5), pp. e801 - e807
Source Title
Publisher
CIG MEDIA GROUP, LP
ISSN
1558-7673
eISSN
1938-0682
Research Team
Cancer Biomarkers
Prostate Cancer Targeted Therapy Group
Clinical Academic Radiotherapy (Dearnaley)
Oncogenetics
Stereotactic and Precision Body Radiotherapy
Prostate Cancer Targeted Therapy Group
Clinical Academic Radiotherapy (Dearnaley)
Oncogenetics
Stereotactic and Precision Body Radiotherapy