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. 2022 Apr;16(4):E220-E226.
doi: 10.5489/cuaj.7525.

Metastatic progression following multimodal therapy for unfavorable-risk prostate cancer

David Guy  1 , Rachel Glicksman  2 , Roger Buckley  3 , Patrick Cheung  2 , Hans Chung  2 , Stanley Flax  3 , David Hajek  3 , Andrew Loblaw  2 , Gerard Morton  2 , Jeffery Noakes  3 , Les Spevack  3 , Joseph L K Chin  1 , George Rodrigues  1
Affiliations

Metastatic progression following multimodal therapy for unfavorable-risk prostate cancer

David Guy et al. Can Urol Assoc J. 2022 Apr.

Abstract

Introduction: Identifying the optimal management of unfavorable-risk (Prostate Cancer Risk Stratification [ProCaRS] high intermediate-, high-, and very high-risk categories) non-metastatic prostate cancer is an important public health concern given the large burden of this disease. We compared the rate of metastatic progression-free survival among men diagnosed with unfavorable-risk non-metastatic prostate cancer who were initially treated with radiation therapy or radical prostatectomy.

Methods: Information was obtained from medical records at two academic centers in Canada from 333 men diagnosed with unfavorable-risk non-metastatic prostate cancer between 2007 and 2012. Median followup was 90.4 months. Men were eligible for the study if they received either primary radiation therapy (n=164) or radical prostatectomy (n=169), in addition to various adjuvant and salvage therapies when deemed clinically appropriate. Patients were matched on prognostic covariates using two matching techniques. Multivariable Cox proportional hazards models were used to estimate the hazard ratios (HR) and confidence intervals (CI) for metastatic progression-free survival between groups.

Results: After matching, treatment groups were balanced on prognostic variables except for percent core positivity. Hazard ratios from all Cox proportional hazards models (i.e., before and after matching, and with and without multivariable adjustment) showed no difference in the rate of metastatic progression-free survival between groups (adjusted unmatched HR 1.16, 95% CI 0.63, 2.13, p=0.64).

Conclusions: Metastatic progression-free survival did not differ between men diagnosed with unfavorable risk non-metastatic prostate cancer who were treated with either radiation therapy or radical prostatectomy.

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Conflict of interest statement

Competing interests: This research was supported by the Ontario Graduate Scholarship program. Some of the work herein originated from the corresponding author’s graduate thesis. Dr. Buckley has been an advisor for Abbvie, Astellas, Ferring, IBCG, TerSera, and Verity. Dr. Cheung has received investigator-initiated research grants from Abbvie, Pfizer, and Sanofi, and speaker honoraria from TerSera. Dr. Chung has receved honoraia from Abbvie. Dr. Loblaw has participated in advisory boards for and received honoraria from Abbvie, Sanofi, and TerSera; has received a research grant from TerSera; has participated in several investigator-initiated studies or CCTG; and is the founder/chair of the Prostate Cure Foundation. The remaining authors do not report any competing personal or financial interests related to this work.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curve showing the probability of metastatic progression-free survival over time stratified by treatment group. RP: radical prostatectomy; RT: radiation therapy.
See this image and copyright information in PMC

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