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Urology. 2016 Oct;96:171-176. doi: 10.1016/j.urology.2016.06.011. Epub 2016 Jun 16.

Predictors of Time to Metastasis in Castration-resistant Prostate Cancer.

Author information

1
Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: moreira.daniel@mayo.edu.
2
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; Urology Section, Veterans Affairs Medical Center, Durham, NC.
3
Urology Section, Veterans Affairs Medical Center, Durham, NC.
4
Urology Section, Department of Surgery, Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, CA; Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA.
5
Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA.
6
Urology Section, Division of Surgery, Veterans Affairs Medical Centers, Augusta, GA; Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA.
7
Division of Urology, Department of Surgery, Oregon Health & Science University, Portland, OR.
8
Departments of Urology and Epidemiology & Biostatistics, University of California, San Francisco, CA; Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA.
9
Amgen Inc., Royal Oaks, MI.
10
Urology Section, Veterans Affairs Medical Center, Durham, NC; Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA.

Abstract

OBJECTIVE:

To investigate predictors of time to metastasis among men treated with androgen deprivation therapy for nonmetastatic prostate cancer who developed castration-resistant prostate cancer (CRPC) within the Shared Equal Access Regional Cancer Hospital cohort.

METHODS:

This is a retrospective analysis of 458 nonmetastatic CRPC men. Metastases were detected in routine bone scans or other imaging tests. Predictors of time to metastasis were analyzed using proportional hazards model with CRPC as time zero.

RESULTS:

A total of 256 (56%) men were diagnosed with metastatic disease over a median follow-up of 36 months. Metastasis-free survival was 79%, 65%, 52%, 47%, and 41% at 1, 2, 3, 4, and 5 years after CRPC, respectively. In multivariable analysis, Gleason score 8-10 (hazard ratio [HR] = 1.61; P = .026), receiving primary localized treatment (HR = 1.38; P = .028), higher prostate-specific antigen (PSA) levels at CRPC diagnosis (logPSA HR = 1.64; P < .001), and PSA doubling time ≤6 months (HR = 1.42; P = .040) were independently associated with shorter time to metastasis. Race, year of CRPC, age, and time from androgen deprivation therapy to CRPC were not associated with metastasis.

CONCLUSION:

Among nonmetastatic CRPC men, nearly 60% developed metastatic disease during the first 5 years, with most of the metastasis occurring within the first 3 years. Higher Gleason score, receiving primary treatment, higher PSA, and shorter PSA doubling time were independently associated with shorter time to metastasis. Therefore, these variables can be used to stratify patients according to metastasis risk.

PMID:
27318265
PMCID:
PMC5536963
DOI:
10.1016/j.urology.2016.06.011
[Indexed for MEDLINE]
Free PMC Article

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