Men who have metastases at the time they are diagnosed with prostate cancer (PCa), compared with those who do not, have worse survival following development of castration-resistant disease, according to Swedish investigators.

Markus Aly, MD, of the Karolinska Institute in Stockholm, and colleagues conducted a population-based study that compared 467 men with castration-resistant prostate cancer (CRPC) who had metastases at the time of PCa diagnosis (the M1 group) and 1123 men who did not (M0 group. Compared with the M0 group, the M1 group had significantly shorter median overall survival (13.2 vs 23.2 months) and cancer-specific survival (13.3 vs 30.3 months), Dr Aly’s team reported in the Scandinavian Journal of Urology.

Among the M0 patients, a biopsy Gleason score of 8 or higher was significantly associated with a 2-fold increased risk all-cause and cancer-specific mortality after CRPC onset compared with a biopsy Gleason score of 6 or less.

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In addition, Dr Aly and colleagues found that patients who experienced onset of CRPC from 2012 onward had lower all-cause and cancer-specific mortality compared with those prior to 2012. Men with M0 and M1 disease whose had CRPC onset from 2012 onward had significant 29% and 40% decreased risks for all-cause mortality, respectively, and 27% and 38% decreased risks for cancer-specific mortality, respectively, compared with those whose CRPC onset occurred prior to 2012.   

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“Overall, patients with M0 disease at the time of diagnosis of PC experienced longer survival from the onset of CRPC than those with M1 disease at the time of diagnosis,” the investigators concluded. “These findings confirm the negative impact of the development of M1 disease on patient outcomes in a real-world setting.”


Aly M, Leval A, Schain F, et al. Survival in patients diagnosed with castrationresistant prostate cancer: a population-based observational study in Sweden [published online April 8, 2020]. Scand J Urol. doi: 10.1080/21681805.2020.1739139