First Metastasis Site Predicts Prostate Cancer-Specific Survival

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Following curative treatment for localized PCa, 5-year PCa-specific survival rates are higher for patients with initial lymph node or locoregional metastases versus initial metastases in bone only or
Following curative treatment for localized PCa, 5-year PCa-specific survival rates are higher for patients with initial lymph node or locoregional metastases versus initial metastases in bone only or

Among men who receive curative treatment for non-metastatic prostate cancer (PCa), the first site of metastasis is an independent predictor of PCa-specific survival, researchers concluded. In addition, PCa-specific survival time depends on the time after metastatic progression rather than the time from diagnosis to metastasis.

Enrico Roggero, MD, of the Oncology Institute of Southern Switzerland in Bellinzona, Switzerland, and colleagues analyzed data from 913 patients who underwent curative surgery (382 patients) or radiotherapy (531 patients) for localized PCa. Clinicians documented all metastases radiographically.

Metastatic hormone-sensitive PCa developed in 136 patients (14.9%). The patients had a median PCa-specific survival of 50.4 months after first metastatic progression. Bone metastases developed in 50 patients (36.8%) and lymph node or locoregional metastases developed in 52 patients (38.2%), the investigators reported online in BMC Cancer. The median PCa-specific survival rates for these groups were 39.7 and 137 months, respectively. Visceral metastases only (liver, brain, lung) developed in 7 patients (5.1%), and metastases at multiple sites developed in 27 patients (19.9%). This latter subgroup had a median PCa-specific survival of 17 months.

The 5-year PCa-specific survival rates were 85% for patients who experienced metastases and 100% for those who did not.

The median metastasis-free survival (MFS) was 49.6 months, with estimated 5- and 10-year MFS rates of 41.9% and 13.2%, respectively. The investigators found no statistically significant differences in MFS according to metastasis subgroups.

In multivariate analysis, the site of first metastasis was an independent prognostic factor for PCa-specific survival, along with Gleason score at diagnosis, the researchers reported. Median metastasis-free survival from primary diagnosis to first metastasis did not correlate with the first site of metastasis.

“Our results provide the conceptual framework for treating patients according to the metastatic disease and advance arguments to introduce location of metastasis as a research parameter in PCa studies,” the authors concluded.

Reference

Pascale M, Azinwi CN, Marongiu B, et al. The outcome of prostate cancer patients treated with curative intent strongly depends on survival after metastatic progression. BMC Cancer. 2017;17:651. doi: 10.1186/s12885-017-3617-6.

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