Real-world outcomes following biochemical recurrence after definitive therapy with a short prostate-specific antigen doubling time: potential role of early secondary treatment

IF 5.1 2区 医学 Q1 ONCOLOGY
Stephen J. Freedland, Wei Gao, Angela Lax, Hongbo Yang, Krishnan Ramaswamy, David Russell, Agnes Hong, Jasmina I. Ivanova
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引用次数: 0

Abstract

Background

The natural history of biochemical recurrence (BCR) managed with delayed hormonal therapy is well documented by data from Johns Hopkins. However, as many patients receive treatment prior to metastasis, we evaluated the natural history and role of prostate-specific antigen doubling time (PSADT) in a more contemporary cohort of BCR patients with nonmetastatic castration-sensitive prostate cancer (nmCSPC).

Methods

Patients in the Veterans Health Administration (VHA; 01/01/06 to 06/22/20) with nmCSPC and BCR were divided into rapid ( ≤9 months) and less rapid ( >9 to ≤15 months) PSADT cohorts. Patients with PSADT >15 months were excluded as outcomes, even with delayed treatment, are excellent. Outcomes included time to first antineoplastic therapy after BCR, metastasis, metastasis-free survival (MFS), and overall survival (OS). Cox models adjusted for baseline demographics and clinical characteristics.

Results

Overall, 781 patients with BCR were identified (502 rapid; 279 less rapid PSADT). Rapid PSADT was associated with shorter time to first systemic antineoplastic therapy (median 11.4 vs. 28.3 months, adjusted hazard ratio [95% confidence interval] 2.17 [1.83–2.57]), metastasis (102.4 months vs. not reached, 1.79 [1.33–2.40]), MFS (76.1 vs. 106.3 months, 1.73 [1.33–2.24]), and OS (120.5 vs. 140.5 months, 1.76 [1.22–2.54]) versus less rapid PSADT.

Conclusion

Most patients with rapid PSADT underwent secondary treatment within 1 year after BCR. More contemporary patients treated with early secondary treatment had better outcomes than historical data from patients who had delayed treatment. Whether these results reflect the benefits of early secondary treatment or overall improvements in prostate cancer outcomes over time requires further study.

Abstract Image

前列腺特异性抗原倍增时间短的确定性治疗后生化复发的真实结果:早期二次治疗的潜在作用
背景约翰霍普金斯大学的数据充分记录了延迟激素治疗后生化复发(BCR)的自然史。方法将退伍军人健康管理局(VHA;01/01/06 至 06/22/20)的 nmCSPC 和 BCR 患者分为 PSADT 快速组(≤9 个月)和 PSADT 较慢组(9 至≤15 个月)。PSADT为15个月的患者不包括在内,因为即使延迟治疗,疗效也非常好。结果包括BCR后首次抗肿瘤治疗的时间、转移、无转移生存期(MFS)和总生存期(OS)。Cox模型对基线人口统计学和临床特征进行了调整。结果共发现781例BCR患者(502例快速PSADT;279例非快速PSADT)。快速 PSADT 与较短的首次全身抗肿瘤治疗时间(中位 11.4 个月 vs. 28.3 个月,调整后危险比 [95% 置信区间] 2.17 [1.83-2.57])、转移(102.4 个月 vs. 未达到,1.79 [1.结论大多数快速 PSADT 患者在 BCR 后 1 年内接受了二次治疗。与延迟治疗的患者的历史数据相比,更多接受早期二次治疗的当代患者的疗效更好。这些结果是反映了早期二次治疗的益处,还是反映了随着时间推移前列腺癌预后的整体改善,还需要进一步研究。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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