CaPSURE update: Examining primary treatment and survival among men with prostate cancer and bony metastatic disease.

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275 Background: New data is emerging to guide primary treatment of patients with metastatic (M+) disease. Among the CHAARTED and LATITUDE cohorts, 27.2% and 5% of patients with M+ disease had prior local therapy, respectively. This study utilizes the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry to examine survival among patients with M+ disease. Methods: CaPSURE is a registry of men diagnosed with prostate cancer. We examined sociodemographics, disease biology, primary therapy, and survival among patients who were diagnosed with cM+ disease or developed metastasis. We performed a multivariate Cox model to evaluate the association between timing of metastasis and prostate cancer specific mortality (PCSM), adjusted for age, primary treatment, and follow-up therapy. Results: Of the 14,753 patients diagnosed with prostate cancer from 1990-2016, 717(4.9%) had M+ disease. 328(2.2%) had cM+ disease and 389(2.6%) progressed to bony metastasis. For all patients with M+ disease, 490(68.3%) were > = 65 yo, 627(87.4%) had Medicare, and 239(33.3%) had an annual income < $30,000 (P < 0.01). PSA at diagnosis was > 20 ng/mL for 355(49.5%) and biopsy Gleason was 4+3 or 8 to 10 for 403(56.2%) (P < 0.01). Among patients with cM+ disease, 49(14.9%) received primary local therapy and 279(85.1%) received primary hormonal therapy. Among patients who progressed to M+ disease, 258(66.3%) received primary local therapy and 131(33.7%) received primary hormonal therapy. The risk of PCSM was worse for patients with M+ disease who received hormonal therapy for primary treatment compared to patients who received combined local and hormonal therapy (HR 1.47 (95% CI 1.15 to 1.88), P < .01). Timing of metastatic disease was not associated with PCSM. Primary treatment with hormonal therapy compared to local therapy was associated with higher risk of PCSM (HR 1.40 (95% CI 1.00-1.97), P = 0.05) for patients diagnosed with Gleason > = 4+3 disease. Conclusions: In our analysis, patients with primary local therapy were examined as a subset of all patients with M+ disease. We observed that patients with cM+ disease have a worse prognosis then patients who develop M+ disease with antecedent primary local therapy.