Do men diagnosed with metastatic prostate cancer benefit from local treatment of the primary tumor? -An OCM matched analysis

Document Type

Conference Proceeding

Publication Date

3-1-2025

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Several studies have already investigated the relationship between local treatment and survival outcomes in metastatic prostate cancer (M+ PCa), but current literature still lacks definitive high-level recommendations. A significant challenge in previous retrospective research has been the clinical selection bias in the study populations, with just “healthier” patients sent to surgery potentially skewing the reported outcomes. By employing a propensity score-matched analysis for other cause mortality (OCM), this study aims to assess how local treatment of the primary site influences prostate cancer-specific mortality (PCSM). Materials & Methods: We retrospectively reviewed patients from the Surveillance, Epidemiology, and End Results (SEER) program database, including M+ PCa (Any T, Any N) diagnosed from 2007 to 2021. The population was stratified into treatment groups: local treatment (radical prostatectomy or radiation therapy) versus no local treatment (ADT or observation). A Cox regression was used to calculate the OCM risk using all available covariates to account for potentially confounding factors. This calculated OCM risk was used to construct a 1:1 propensity score-matched cohort. In the matched cohort, the cumulative incidence function was used to assess the PCSM rates, and competing-risks multivariable analysis tested the impact of treatment on PCSM. Results: A total of 13812 patients were identified, mostly Non-Hispanic-Whites (72%) and Non-Hispanic-Blacks (20%) with a median age of 65 years. Most of them were classified as pT3/4 (31%) and with a Gleason score ≥8 (81%) in both groups. In the matched cohort, the 10-year cumulative incidence of OCM was not statistically significantly different between treatment groups (13.8% vs. 14.8% p=0.3), confirming a good match between the populations. Whereas the 10-year cumulative incidence of PCSM was lower in the local treatment group (56.5% vs. 68.6%, p<0.001). On competing-risks multivariable analysis, the Local treatment group had a 0.83 lower risk of PCSM than the no local treatment group (Hazard ratio 0.83, 95% Confidence Interval 0.79-0.87, p<0.001). Conclusions: Our analysis confirms that local treatment significantly reduces PCSM in metastatic settings, outperforming no local treatment, even after adjusting for potential confounders and the clinical selection bias. These findings reignite the need for dedicated clinical trials, to resume investigation into local treatment strategies.

Volume

87

Issue

S1

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