Impact of Cerebrovascular Disease on Survival Benefits from Local Treatment in Patients with De Novo Metastatic Hormone-Sensitive Prostate Cancer
10.3349/ymj.2019.60.12.1129
- Author:
Tae Jin KIM
1
;
Young Dong YU
;
Dong Soo PARK
;
Koon Ho RHA
;
Sung Joon HONG
;
Kang Su CHO
;
Byung Ha CHUNG
;
Kyo Chul KOO
Author Information
1. Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
- Publication Type:Original Article
- Keywords:
Cerebrovascular disorders;
neoplasm metastasis;
prostatic neoplasms;
survival
- MeSH:
Cerebrovascular Disorders;
Cohort Studies;
Follow-Up Studies;
Humans;
Kaplan-Meier Estimate;
Male;
Mortality;
Neoplasm Metastasis;
Prospective Studies;
Prostate;
Prostatectomy;
Prostatic Neoplasms;
Retrospective Studies
- From:Yonsei Medical Journal
2019;60(12):1129-1137
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Local treatment has become a treatment option for patients with de novo metastatic hormone-sensitive prostate cancer (mHSPC). Subgroup analyses based on a history of cerebrovascular disease (CVD) were performed to evaluate the impact thereof on overall survival (OS) after local treatment. MATERIALS AND METHODS: A retrospective analysis was performed for 879 patients with de novo mHSPC between August 2003 and November 2016. Patients were stratified according to prior CVD history and the type of initial treatment: androgen-deprivation therapy (ADT) alone versus local treatment consisting of radical prostatectomy (RP) or radiation therapy (RT) with ADT, with or without metastasis-directed therapy. The primary outcome was OS assessed by Kaplan-Meier analysis and Cox-regression models. RESULTS: Of 879 patients, 660 (75.1%) men underwent ADT alone, and 219 (24.9%) men underwent RP or RT with ADT, with or without metastasis-directed therapy. The median follow-up was 38 months. Multivariable analysis showed CVD history to be associated with a higher risk of overall mortality (p=0.001). In the overall cohort and in patients without a history of CVD, patients who underwent local treatment exhibited higher OS than men who received ADT alone (all p<0.001). However, the survival benefit conferred by local treatment was not seen in patients with a history of CVD (p=0.324). OS was comparable between patients who received RP and RT (p=0.521). CONCLUSION: Local treatment with or without metastasis-directed therapy may provide OS advantages for mHSPC patients without a history of CVD. Further prospective studies are needed to address these important concerns.
