MP32-05 CONTEMPORARY HISTORY OF PROGRESSION FOLLOWING ANDROGEN DEPRIVATION THERAPY FOR BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP32)1 Sep 2021MP32-05 CONTEMPORARY HISTORY OF PROGRESSION FOLLOWING ANDROGEN DEPRIVATION THERAPY FOR BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY Timothy Daskivich, Shannon Stock, William Aronson, Martha Terris, Zachary Klaassen, Christopher Kane, Christopher Amling, Matthew Cooperberg, and Stephen Freedland Timothy DaskivichTimothy Daskivich More articles by this author , Shannon StockShannon Stock More articles by this author , William AronsonWilliam Aronson More articles by this author , Martha TerrisMartha Terris More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Christopher KaneChristopher Kane More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002036.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with biochemical recurrence (BCR) after radical prostatectomy (RP) who are not treated with early androgen deprivation therapy (ADT) have a median time to metastasis of 8 years based on natural history data from the pre-2000s era. We sought to characterize risks of castration-resistant prostate cancer (CRPC) and metastasis in a contemporary VA cohort treated with early ADT for BCR after RP. METHODS: We analyzed 810 men with nonmetastatic prostate cancer starting ADT for non-metastatic BCR after RP from 1988–2017 in the VA SEARCH database. Multivariable Cox proportional hazards analysis was used to identify predictors of CRPC and metastasis. Kaplan-Meier analysis was used to quantify risk across key predictors. RESULTS: Median follow up was 5.7 years (IQR 3.1,9.6) after ADT. Median PSA at ADT was 1.4 ng/mL (IQR 0.3, 5.0). Across all men, 8-year risk of metastasis was 22%. In multivariable models, higher pre-ADT PSA (HR 1.78, p <0.001), seminal vesicle invasion (HR 1.69, p=0.004), shorter pre-ADT PSA doubling time (PSADT) (p=0.002), higher pathologic grade group (GG) (p=0.01), and higher BMI (p=0.007) were associated with higher risk of metastasis. 8-year risk of metastasis among those at highest risk with pre-ADT PSADT <3 mos, pathological GG5, or pre-ADT PSA of ≥10 was 27%, 32%, and 41%, respectively (Figure). Across all men, 8-year risk of CRPC was 25%. In multivariable models, higher pre-ADT PSA (HR 1.81, p <0.001), seminal vesicle invasion (HR 1.84, p <0.001), shorter pre-ADT PSADT (p <0.001), higher pathological GG (p=0.008), higher BMI (p=0.003), radiation before ADT (HR 1.62, p=0.01) and longer time from BCR to ADT (HR 1.01, p=0.01) were associated with higher risk of CRPC. Positive surgical margins (HR 0.69, p=0.03) and earlier year of ADT (HR 0.94, p=0.002) were associated with lower risk of CRPC. 8-year risk of CRPC among those at highest risk with pre-ADT PSADT <3 mos, pathological GG5, or pre-ADT PSA of ≥10 was 32%, 34%, and 50%, respectively. CONCLUSIONS: Risks of metastasis and CRPC after ADT for post-RP BCR are lower than in the historical literature for men not treated with ADT, with only 25% progressing to CRPC and 22% to metastasis after 8 years. Even in high risk subgroups, risks of metastases or CRPC at 8-years were <50%, demonstrating the long natural history of early ADT. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e566-e566 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Daskivich More articles by this author Shannon Stock More articles by this author William Aronson More articles by this author Martha Terris More articles by this author Zachary Klaassen More articles by this author Christopher Kane More articles by this author Christopher Amling More articles by this author Matthew Cooperberg More articles by this author Stephen Freedland More articles by this author Expand All Advertisement Loading ...