950 IMPACT OF PRIOR LOCAL THERAPY ON SURVIVAL IN MEN RECEIVING CHEMOTHERAPY FOR METASTATIC PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced III1 Apr 2012950 IMPACT OF PRIOR LOCAL THERAPY ON SURVIVAL IN MEN RECEIVING CHEMOTHERAPY FOR METASTATIC PROSTATE CANCER Oluwakayode Adejoro, Sean Elliott, and Badrinath Konety Oluwakayode AdejoroOluwakayode Adejoro Minneapolis, MN More articles by this author , Sean ElliottSean Elliott Minneapolis, MN More articles by this author , and Badrinath KonetyBadrinath Konety Minneapolis, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1048AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The benefit of prior local therapy in the form of radiation or radical prostatectomy in men who subsequently go on to develop metastatic disease and receive chemotherapy is not well characterized. We sought to assess the impact of a previously treated primary tumor in the prostate on survival following androgen suppression therapy and chemotherapy for metastatic prostate cancer in men who progress to develop metastatic disease. METHODS Using the SEER Medicare dataset from 1992-2007, we identified all men with a diagnosis of prostate cancer who received chemotherapy commonly used to treat prostate cancer and androgen suppression therapy (AST) (n=109,794). After eliminating those diagnosed at autopsy, from Louisiana (2005 year), inadequate information about AST or < 6 months of AST, prior or subsequent diagnosis of a second primary and with unknown or missing variables, we identified a cohort of 23,618 men. We compared cancer specific survival and overall survival among men who had previously undergone radical prostatectomy, radiation therapy/brachytherapy and neither of these types of therapy for primary tumor. Cox proportional hazard models were used to assess survival. RESULTS A majority of the patients were >70 years and Caucasian. They had medium or high grade tumors and were diagnosed at stage T1-2. 5% had undergone RP and 93% had received prior radiation while 1.7% received no therapy for primary tumor. About 88% of the patients had a Charlson score of 0-1. Cancer specific survival was significantly worse among men who had neither surgery nor radiation for primary tumor when compared to those who had prior radical prostatectomy (HR 5.313 p<0.0001). There was no difference in cancer specific survival among those who underwent surgery or radiation for their primary tumor. Overall survival was worse among those who received radiation (HR 1.4 p<0.0001) or neither surgery nor radiation (HR 4.06 p<0.0001) compared to those who had surgery. CONCLUSIONS Prior therapy to the primary prostate cancer in the form of radical prostatectomy or radiation appears to confer a survival advantage in patients who subsequently go on to develop metastatic disease and receive androgen suppressive therapy and chemotherapy. If further validated, this suggests that radical prostatectomy or radiation therapy could be considered even among men found to have incidental regional metastatic disease at the time of surgery or on imaging. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e386-e387 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oluwakayode Adejoro Minneapolis, MN More articles by this author Sean Elliott Minneapolis, MN More articles by this author Badrinath Konety Minneapolis, MN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...