724 TRANS-PACIFIC VARIATION IN OUTCOMES FOR MEN TREATED WITH PRIMARY ANDROGEN DEPRIVATION THERAPY FOR LOCALIZED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced (I)1 Apr 2013724 TRANS-PACIFIC VARIATION IN OUTCOMES FOR MEN TREATED WITH PRIMARY ANDROGEN DEPRIVATION THERAPY FOR LOCALIZED PROSTATE CANCER Matthew Cooperberg, Shiro Hinotsu, Mikio Namiki, Peter Carroll, and Hideyuki Akaza Matthew CooperbergMatthew Cooperberg San Francisco, CA More articles by this author , Shiro HinotsuShiro Hinotsu Kyoto, Japan More articles by this author , Mikio NamikiMikio Namiki Kanazawa, Japan More articles by this author , Peter CarrollPeter Carroll San Francisco, CA More articles by this author , and Hideyuki AkazaHideyuki Akaza Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.283AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary androgen deprivation therapy (PADT) is endorsed as an option for monotherapy for localized prostate cancer by guidelines in Asia but not in the United States (US) or Europe. PADT use is common, however, in both the US and Japan. Prior studies on either side of the Pacific have reported disparate outcomes for PADT; we aimed to explore these differences in a direct comparison study. METHODS Data were drawn from the US community-based CaPSURE registry and from J-CaP, comprising men in Japan treated with PADT. 1934 men treated with PADT were included from CaPSURE, and 16,300 treated in J-CaP. Risk adjustment was based on the validated Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score. Cox propor-tional hazards regression was used to assess prostate cancer-specific mortality (CSM), adjusting for age, J-CAPRA, year of diagnosis, and treatment type (combined androgen blockade [CAB] vs. castration (medical or surgical) monotherapy). RESULTS Men treated with PADT in J-CaP were older than those in CaPSURE (mean age 75.0 vs. 72.7, p<0.001), and had higher risk disease (mean J-CAPRA score 3.0 vs. 2.1, p<0.001). They were more likely to be treated with CAB: 67.1% vs. 44.5% (p<0.001). In the Cox model, the hazard ratio (HR) for PCSM was 0.31 for J-CaP compared to CaPSURE, 95% CI 0.25?0.40. In J-CaP, CAB improved survival compared to castration alone (HR 0.81, 95% CI 0.66?1.0), but this effect was not observed in CaPSURE (HR 0.96, 95% CI 0.69?1.34). For all-cause mortality, the HR for J-CaP was 0.27 (95% CI 0.24?0.30). CONCLUSIONS Adjusting for multiple factors including disease risk and type of androgen ablation, men treated with PADT in Japan compared to the US have more than 3-fold lower CSM and 4-fold better overall survival. CAB improved outcomes compared to castration alone in J-CaP but not in CaPSURE. These findings support existing guidelines both encouraging PADT in Asia and discouraging its use in the West. The reasons for these substantial differences likely include both genetic and dietary/environmental factors, as well as potential confounding variables such as comorbidities. Such factors may explain varying biology of prostate cancer on both sides of the Pacific. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e297 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Cooperberg San Francisco, CA More articles by this author Shiro Hinotsu Kyoto, Japan More articles by this author Mikio Namiki Kanazawa, Japan More articles by this author Peter Carroll San Francisco, CA More articles by this author Hideyuki Akaza Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...