PD57-02 NATIONAL CANCER DATABASE ANALYSIS ASSESSING THE IMPACT OF TREATMENT MODALITIES ON SURVIVAL OUTCOMES IN LOCALIZED NEUROENDOCRINE PROSTATE ADENOCARCINOMA

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD57)1 Sep 2021PD57-02 NATIONAL CANCER DATABASE ANALYSIS ASSESSING THE IMPACT OF TREATMENT MODALITIES ON SURVIVAL OUTCOMES IN LOCALIZED NEUROENDOCRINE PROSTATE ADENOCARCINOMA Chandler Bronkema, Sohrab Arora, Jacob Keeley, Nikola Rakic, Akshay Sood, Deepansh Dalela, Maxwell Stricker, Phil Olson, Craig G. Rogers, Mani Menon, and Firas Abdollah Chandler BronkemaChandler Bronkema More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Nikola RakicNikola Rakic More articles by this author , Akshay SoodAkshay Sood More articles by this author , Deepansh DalelaDeepansh Dalela More articles by this author , Maxwell StrickerMaxwell Stricker More articles by this author , Phil OlsonPhil Olson More articles by this author , Craig G. RogersCraig G. Rogers More articles by this author , Mani MenonMani Menon More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002091.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neuroendocrine (NEC) adenocarcinoma is considered a rare histological variant of prostate adenocarcinoma (PCa). Given the rarity of this malignancy, optimal treatment strategies for men with nonmetastatic NEC PCa is largely unknown. We sought to describe the impact of initial surgery, radiotherapy (RT), systemic therapy (ST) and observation on overall survival (OS) in men with nonmetastatic NEC PCa. METHODS: We selected 456 cases of localized NEC PCa, diagnosed between 2004 and 2015, within the National Cancer Database. Covariates included age, race, Charlson comorbidity score, clinical T stage, clinical lymph node stage, serum prostate specific antigen (PSA), and income. Cox regression analysis tested the impact of treatment (surgery, RT, ST and observation) on OS after adjusting for all covariates. Adjusted Kaplan-Meier estimates were used to visualize the impact of treatment modality on OS. RESULTS: In men with nonmetastatic NEC PCa, median (IQR) age and PSA were 70 (63-78) years and 5.3 (2.1-11.1) ng/mL, respectively. Advanced local stage (≥cT3a) was most frequently observed in patients treated with ST (52.6%), followed by those treated with RT (40.2%), observation (20.0%) and surgery (15.9%, p<0.001). Serum PSA at presentation was highest in the ST cohort (median 15.6 ng/ml, IQR: 1.6-49.1), followed by the surgery (median 5.9 ng/ml, IQR: 4.0-9.6) and observation cohorts (median 5.9 ng/ml, IQR: 1.6-11.3), and finally, the RT cohort (median 4.6 ng/ml, IQR: 1.9-11.3, p=0.002). Estimated 5-year OS was highest in the surgery cohort (58.1%), followed by the RT (33.8%), observation (13.6%) and ST cohorts (7.9%; all p<0.001). Adjusted Kaplan-Meier estimates are displayed in the figure below. Multivariable analysis showed that compared to men treated surgically, OS was significantly lower for patients under observation (HR 5.2; 95% CI: 2.5-10.6); however, OS was not significantly different for patients receiving RT (HR 1.0; 95% CI: 0.6-1.6) or ST (HR 1.7; 95% CI: 0.9-3.2). CONCLUSIONS: In men diagnosed with localized neuroendocrine PCa, initial surgical treatment is associated with more favorable OS outcomes compared to observation but not RT or ST. Our findings should be interpreted within the framework of a retrospective study design. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1009-e1010 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chandler Bronkema More articles by this author Sohrab Arora More articles by this author Jacob Keeley More articles by this author Nikola Rakic More articles by this author Akshay Sood More articles by this author Deepansh Dalela More articles by this author Maxwell Stricker More articles by this author Phil Olson More articles by this author Craig G. Rogers More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Loading ...