Post-metastasis survival in high-risk localised and locally advanced prostate cancer patients undergoing primary treatment in the United States: A retrospective study

Despite available treatments such as radical prostatectomy (RP) or radiotherapy (RT) with/without androgen deprivation therapy (±ADT), high-risk localised or locally advanced prostate cancer (HiR-LPC/LAPC) patients (pts) are at high risk of disease progression, specifically to metastasis (mets). There is a lack of evidence on the post-mets survival (PMS) of pts following these different treatment modalities and whether time to mets (TTM) determines their PMS. This study investigated the characteristics and PMS of HiR LPC/LAPC pts receiving either RP, RT, or RT+ADT, including the impact of TTM on their PMS.

Data from ConcertAI Patient360TM, predominantly from medical oncologists, was queried from January 2000 October 2022 for men, age ≥18 years, to identify HiR-LPC/LAPC pts (based on NCCN criteria) who underwent either RP, RT, or RT+ADT prior to developing mets. The PMS of these pts was examined using Kaplan-Meier methods and hazard ratios (HRs) of PMS were obtained from Cox models.

This study included 1,231 HiR-LPC/LAPC pts who developed mets after primary treatment with RP (n=84), RT (n=262), and RT+ADT (n=885). RP pts were younger than RT and RT+ADT pts both at time of primary treatment and at mets diagnosis and showed longer TTM (Table 1). There was a high level of missingness in important prognostic factors other than age (e.g., Charlson Comorbidity Index [CCI] and ECOG performance status). RP pts exhibited longer median PMS than RT and RT+ADT pts (Table 1), but these differences lost statistical significance after controlling for age (Model 1 in Table 2). The TTM of HiR-LPC/LAPC pts appears to be unrelated to their PMS

This study based on data predominantly from oncologists showed that RP was associated with better PMS, a finding likely explained by age differences between pts. Moreover, PMS was unrelated to TTM, suggesting that PMS may be a constant length of time regardless of how one gets to metastases and thus the best way to improve overall survival is by delaying the development of metastases. Future research should explore data sources with higher urology practice representation, and more granular data on prognostic factors (e.g., ECOG, CCI, disease volume, treatment received) and castration resistance.