Yonsei Med J.  2019 Dec;60(12):1129-1137. 10.3349/ymj.2019.60.12.1129.

Impact of Cerebrovascular Disease on Survival Benefits from Local Treatment in Patients with De Novo Metastatic Hormone-Sensitive Prostate Cancer

Affiliations
  • 1Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
  • 2Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. gckoo@yuhs.ac

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.

Keyword

Cerebrovascular disorders; neoplasm metastasis; prostatic neoplasms; survival

MeSH Terms

Cerebrovascular Disorders*
Cohort Studies
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Mortality
Neoplasm Metastasis
Prospective Studies
Prostate*
Prostatectomy
Prostatic Neoplasms*
Retrospective Studies

Figure

  • Fig. 1 Kaplan-Meier curves showing overall survival in patients stratified by a history of cerebrovascular disease (CVD). (A) Overall group, (B) patients without a history of CVD, and (C) patients with a history of CVD. ADT, androgen-deprivation therapy.


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