Men who have metastatic prostate cancer (PCa) at initial presentation are less likely to die from the malignancy compared with men who progress to metastatic PCa after initial therapy, according to a new study.

The finding suggest that “these entities may have distinct biology informed by prior treatment exposure,” Hala T. Borno, MD, of the University of California, San Francisco, and collaborators concluded in a report published in Urologic Oncology.

The study examined data from 14,753 patients in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry diagnosed with PCa from 1990 to 2016. Of these, 669 (5%) had metastatic disease: 303 (45%) at diagnosis (de novo metastatic PCa) and 366 (55%) who progressed to metastatic disease after initial therapy (recurrent metastatic PCa).

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The median follow-up time was 40 months for men with de novo metastatic PCa compared with 22 months for those with recurrent metastatic PCa. Among the patients with metastatic disease at diagnosis, 21 (10%) received initial local therapy and 272 (90%) received initial hormonal therapy. Among patients who progressed to metastatic disease, 239 (65%) received initial local therapy and 127 (35%) received initial systematic hormonal therapy.

After adjusting for sociodemographic factors, diagnosis year, comorbidities, and marital status, patients with metastatic disease at diagnosis had a significant 34% lower risk of cancer-specific mortality than those who progressed to metastatic disease (P =.002), the investigators reported. The investigators found no difference in the stratified analysis between men who received combined local and hormonal therapy compared with local therapy alone.

“These data support the notion that local management may not confer a survival benefit in an unselected population of patients with metastatic disease,” the authors wrote.

Dr Borno and colleagues concluded that their data “contribute to the growing literature characterizing the role of local therapy as part of an evolving treatment landscape for advanced disease.”


Borno HT, Cowan JE, Zhao S, et al. Examining initial treatment and survival among men with metastatic prostate cancer: An analysis from the CaPSURE registry. Urol Oncol. Published online August 8, 2020. doi:10.1016/j.urolonc.2020.07.012