1. Patterns of recurrence and modes of progression after metastasis-directed therapy in oligometastatic castration-sensitive prostate cancer
- Author
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Samuel R. Denmeade, Emmanuel S. Antonarakis, Channing J. Paller, Kekoa Taparra, Curtiland Deville, Sean S. Park, Phuoc T. Tran, R.W. Gao, Danny Y. Song, Kenneth J. Pienta, Eugene D. Kwon, Dyda Dao, Mario A. Eisenberger, Ryan Phillips, Kenneth R. Olivier, Theodore L. DeWeese, Luanna Chan, Stephen Greco, Bradley J. Stish, Michael A. Carducci, and Matthew P. Deek
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,medicine.drug_class ,Clinical study design ,Hazard ratio ,Disease ,Androgen ,medicine.disease ,SABR volatility model ,Article ,030218 nuclear medicine & medical imaging ,Metastasis ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Survival analysis - Abstract
Purpose: Metastasis-directed therapy (MDT) is increasingly used in castration-sensitive oligometastatic prostate cancer because it prolongs progression-free survival (PFS) and androgen deprivation free survival. Here we describe patterns of recurrence and identify modes of progression after MDT using SABR. Methods and Materials: Two hundred fifty-eight patients with castration-sensitive oligometastatic prostate cancer (≤5 lesions at staging) were retrospectively identified from a multi-institutional database. Descriptive patterns of recurrence and modes of progression were reported. Other outcomes including median time to prostate-specific antigen (PSA) recurrence, time to next intervention, distant metastasis–free survival, overall survival, and biochemical PFS (bPFS) were reported. Survival analysis was performed using the Kaplan-Meier method, and multivariable analysis was performed. Results: Median follow-up was 25.2 months, and 50.4% of patients received concurrent androgen deprivation. Median time to PSA recurrence was 15.7 months, time to next intervention was 28.6 months, distant metastasis–free survival was 19.1 months, and bPFS was 16.1 months. Two-year overall survival was 96.8%. On multivariable analysis, factors associated with bPFS included age (hazard ratio [HR], 1.03; P = .04), N1 disease at diagnosis (HR, 2.00; P = .02), M1 disease at diagnosis (HR, 0.44; P = .01), initial PSA at diagnosis (HR, 1.002; P = 3 lesions]) occurring in 23.1% of patients. Conclusions: After MDT, the majority of patients have long-term control or oligoprogression (class I or II). Recurrence tended to occur in osseous sites. These findings, if validated, have implications for future integration of MDT and clinical trial design.
- Published
- 2020