Abstract
This study aimed to compare the effects of abiraterone acetate plus prednisone (AAP) with androgen deprivation therapy (ADT) with those of combined androgen blockade (CAB) therapy in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). This study retrospectively identified 163 patients with high-risk mHSPC at Kindai University and affiliated hospitals between January 2014 and December 2020. Kaplan-Meier analysis was used to summarize progression-free survival (PFS) and overall survival (OS). Multivariate Cox proportional hazard modeling was used to identify the prognostic factors in the overall cohort. Propensity score matching was used to adjust the clinical characteristics, and log-rank test was applied to these propensity score–matched cohorts. Seventy-four patients who received AAP with ADT and 89 patients who received CAB were included in this study. The median follow-up duration was 27 months (range, 2–89 months). The median PFS and OS were not reached by the AAP+ADT group and 15 and 79 months, respectively, in the CAB group. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) score and AAP+ADT were significant prognostic factors for PFS, whereas ECOG PS score, visceral metastasis, and AAP+ADT were significant prognostic factors for OS. The 2-year PFS was 76.1% in the AAP+ADT group and 38.6% in the CAB group (P < 0.0001), and the 2-year OS was 90.2% in the AAP+ADT group and 84.8% in the CAB group (P = 0.015). In conclusion, AAP+ADT had better PFS and OS than CAB in patients with high-risk mHSPC.
Highlights
Prostate cancer is the most common cancer and the second most common cause of death in the United States
Sixteen (21.6%) of 74 patients in the acetate plus prednisone (AAP)+Androgen deprivation therapy (ADT) group and 65 (73.0%) of 89 patients in the Combined androgen blockade (CAB) group progressed to castration-resistant prostate cancer (CRPC)
Results from LATITUDE and STAMPEDE showed that Gleason score, Eastern Cooperative Oncology Group (ECOG) performance status (PS) score, and nodal status were not prognostic factors for overall survival (OS) in Metastatic hormone-sensitive prostate cancer (mHSPC) patients treated with AAP +ADT compared with those treated with ADT alone, but the benefit of AAP+ADT was greater in younger men [15]
Summary
The 5-year relative survival rate of patients with metastatic prostate cancer is 30% [1]. Metastatic hormone-sensitive prostate cancer (mHSPC) accounts for up to 5% of patients newly diagnosed with prostate cancer in the United States [3]. Combined androgen blockade (CAB) therapy with a standard nonsteroidal antiandrogen drug (bicalutamide or flutamide) is not recommended with systemic therapy for castration-naïve disease according to the National Comprehensive Cancer Network clinical practice guidelines in oncology, but it is recommended as grade B in the Japanese Urological Association guidelines. CAB therapy may be superior to other hormone therapies for overall survival (OS) in patients with mHSPC in Japan [4]. The rate of CAB therapy in primary hormone therapy is higher in Japan than in Western Europe, and the cancer-specific mortality rate is less than half that in the United States [5]. The dosage of bicalutamide in Japan and Western Europe differs (80 and 50 mg, respectively)
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