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

Diletta Bianchini, David Lorente, Pasquale Rescigno, Zafeiris Zafeiriou, Elena Psychopaida, Hazel O'Sullivan, Mervyn Alaras, Michael Kolinsky, Semini Sumanasuriya, Mariane Sousa Fontes, Joaquin Mateo, Raquel Perez Lopez, Nina Tunariu, Nikolaos Fotiadis, Pardeep Kumar, Alison Tree, Nicholas Van As, Vincent Khoo, Chris Parker, Rosalind EelesAlan Thompson, David Dearnaley, Johann S. de Bono

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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.

Original languageEnglish
Pages (from-to)e801-e807
Number of pages7
JournalClinical Genitourinary Cancer
Volume15
Issue number5
DOIs
Publication statusPublished - Oct 2017
Externally publishedYes

Keywords

  • Abscopal effect
  • Local disease
  • Local treatment
  • Metastatic CRPC
  • Radiotherapy

Cite this

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., ... de Bono, J. S. (2017). 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. Clinical Genitourinary Cancer, 15(5), e801-e807. https://doi.org/10.1016/j.clgc.2017.04.013