Browse by author
Lookup NU author(s): Dr Pasquale RescignoORCiD
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
© The Author(s), under exclusive licence to Springer Nature Limited 2024. Background: Currently, several therapies are available for metastatic castration-resistant prostate cancer (mCRPC) but no specific clinical factors to personalize treatment. We first sought the prognostic value of duration on androgen-deprivation therapy (ADT) for hormone-sensitive prostate cancer (HSPC) in patients receiving androgen-receptor-signaling inhibitors (ARSI) for mCRPC. Methods: A multicenter cohort of mCRPC patients who started ARSI between July 2011 and October 2021 was identified. Based on their initial disease burden and duration on ADT for HSPC, primary progressive (PP) men were classified into four groups: low/intermediate-risk localized disease (LOC) and high-risk localized/locally advanced disease (LAD) and short-term (ST) < 24 vs. long-term (LT) ADT ≥ 24 months, whereas de novo (DN) mHSPC were subdivided into short-time vs. long-time to CRPC. Results: We included 919 mCRPC patients with a median age of 77 years [interquartile range (IQR) = 71–82)]. Median ADT duration in HSPC was 24 months (IQR = 14–40). Median follow-up was 91 months (IQR = 62–138), median OS and PFS from ARSI start were 20 (IQR 10–32) and 10 months (IQR = 5–19), respectively. In PP developing metastatic disease (n = 655, 71.3%), LOC and LAD with ST ADT had a greater than almost double-risk of death compared to LT ADT (LOC/ST: hazard ratio [HR] = 2.01; 95% CI 1.54–2.64; LAD/ST: HR = 1.73; 95% CI 1.34–2.24; p < 0.001). In the multivariate analysis including age, prognostic cohort, Gleason, ECOG, radical radiotherapy and prostatectomy, groups with ST ADT were associated with worse OS compared to LT ADT (LOC/ST: HR = 1.84; 95% CI 1.38–2.45; p < 0.001; LAD/ST: HR = 1.59; 95% CI 1.21–2.10; p < 0.001), along with ECOG > 2 (HR = 1.55; 95% CI 1.06–2.26; p = 0.03). There were also similar results of PFS. Moreover, long-time to CRPC in patients with history of DN mHSPC (n = 264, 28.7%) resulted in a better OS/PFS (HR = 0.76, 95% CI 0.56–1.02, p = 0.064 and HR = 0.74, 95% CI 0.55–0.99, p = 0.042, respectively). Conclusions: Our study showed that duration on ADT for mHSPC was significantly associated with survival in mCRPC undergoing ARSI. These findings suggest a possible connection between initial management of prostate tumour and a better prognostication in mCRPC. Prospective trials are warranted.
Author(s): Conteduca V, Di Tullio P, Allamprese R, Bruno G, Lolli C, Schepisi G, Rosano A, Giordano G, Garofoli M, Chiuri VE, Fratino L, Zanardi E, Galli L, Massari F, Falagario U, Rescigno P, Fornarini G, Sanguedolce F, Santini D, Procopio G, Caffo O, Carrieri G, Landriscina M, De Giorgi U
Publication type: Article
Publication status: Published
Journal: Prostate Cancer and Prostatic Diseases
Year: 2024
Pages: ePub ahead of print
Online publication date: 12/02/2024
Acceptance date: 23/01/2024
ISSN (print): 1365-7852
ISSN (electronic): 1476-5608
Publisher: Springer Nature
URL: https://doi.org/10.1038/s41391-024-00800-8
DOI: 10.1038/s41391-024-00800-8
Altmetrics provided by Altmetric
