Abstract
BackgroundTo evaluate the impact of time to castration resistance (TTCR) in metastatic hormone-sensitive prostate cancer (mHSPC) patients on overall survival (OS) in the era of combination therapies for mHSPC.Material and MethodsOf 213 mHSPC patients diagnosed between 01/2013-12/2020 who subsequently developed metastatic castration resistant prostate cancer (mCRPC), 204 eligible patients were analyzed after having applied exclusion criteria. mHSPC patients were classified into TTCR <12, 12-18, 18-24, and >24 months and analyzed regarding OS. Moreover, further OS analyses were performed after having developed mCRPC status according to TTCR. Logistic regression models predicted the value of TTCR on OS.ResultsMedian follow-up was 34 months. Among 204 mHSPC patients, 41.2% harbored TTCR <12 months, 18.1% for 12-18 months, 15.2% for 18-24 months, and 25.5% for >24 months. Median age was 67 years and median PSA at prostate cancer diagnosis was 61 ng/ml. No differences in patient characteristics were observed (all p>0.05). According to OS, TTCR <12 months patients had the worst OS, followed by TTCR 12-18 months, 18-24 months, and >24 months, in that order (p<0.001). After multivariable adjustment, a 4.07-, 3.31-, and 6.40-fold higher mortality was observed for TTCR 18-24 months, 12-18 months, and <12 months patients, relative to TTCR >24 months (all p<0.05). Conversely, OS after development of mCRPC was not influenced by TTCR stratification (all p>0.05).ConclusionPatients with TTCR <12 months are at the highest OS disadvantage in mHSPC. This OS disadvantage persisted even after multivariable adjustment. Interestingly, TTCR stratified analyses did not influence OS in mCRPC patients.
Highlights
Prostate cancer is the most common cancer in men and is the second and third most common cause of cancerspecific mortality in the United States and Europe [1,2,3]
MCRPC Definition metastatic castration resistant prostate cancer (mCRPC) status was defined in accordance with the EAU guidelines [4]: PSA progression of three consecutive rises of PSA values or a 50% increase of absolute PSA values over the PSA nadir under metastatic hormonesensitive prostate cancer (mHSPC) treatment combined with a testosterone level
Median age and PSA at prostate cancer diagnosis did not differ between the four time to castration resistance (TTCR) groups
Summary
Prostate cancer is the most common cancer in men and is the second and third most common cause of cancerspecific mortality in the United States and Europe [1,2,3]. Two Japanese studies focused on the effect of differences in time to castration resistance (TTCR) on OS [15, 16]. These studies relied exclusively on patients treated with either ADT alone or combination of ADT plus bicalutamide in mHSPC. Little if anything is known about the impact of differences in TTCR on survival in the era of the abovedescribed combination therapies, especially in European mHSPC patients. To evaluate the impact of time to castration resistance (TTCR) in metastatic hormone-sensitive prostate cancer (mHSPC) patients on overall survival (OS) in the era of combination therapies for mHSPC
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