Limited data exist on the impact of the site of metastases on survival in patients with stage IV prostate cancer (PCa).
To investigate the role of metastatic phenotype at presentation on mortality in stage IV PCa.
Design, setting, and participants
Overall, 3857 patients presenting with metastatic PCa between 1991 and 2009, included in the Surveillance Epidemiology and End Results–Medicare database were evaluated.
Outcome measurements and statistic analyses
Overall and cancer-specific survival rates were estimated in the overall population and after stratifying patients according to the metastatic site (lymph node [LN] alone, bone, visceral, or bone plus visceral). Multivariable Cox regression analyses tested the relationship between the site of metastases and survival. All analyses were repeated in a subcohort of patients with a single metastatic site involved.
Results and limitations
Respectively, 2.8%, 80.2%, 6.1%, and 10.9% of patients presented with LN, bone, visceral, and bone plus visceral metastases at diagnosis. Respective median overall survival and cancer-specific survival were 43 mo and 61 mo for LN metastases, 24 mo and 32 mo for bone metastases, 16 mo and 26 mo for visceral metastases, and 14 mo and 19 mo for bone plus visceral metastases (p < 0.001). In multivariable analyses, patients with visceral metastases had a significantly higher risk of overall and cancer-specific mortality versus those with exclusively LN metastases (p < 0.001). The unfavorable impact of visceral metastases persisted in the oligometastatic subgroup. Our study is limited by its retrospective design.
Visceral involvement represents a negative prognostic factor and should be considered as a proxy of more aggressive disease in patients presenting with metastatic PCa. This parameter might indicate the need for additional systemic therapies in these individuals.
Patients with visceral metastases should be considered as affected by more aggressive disease and might benefit from the inclusion in clinical trials evaluating novel molecules.
Keywords: Metastatic prostate cancer, Overall survival, Prostate cancer, Androgen deprivation therapy, Site of metastases, Number of metastases.
a Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
b Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
c Department of Urology, University of Montreal Health Center, Montreal, Canada
d Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
Corresponding author. University of Montreal Health Center, 1058, rue St-Denis, Montreal, QC, H2X 3J4, Canada. Tel. +1 514 890 8000 ext. 35335; Fax: +1 514 227 5103.
These authors contributed equally.
© 2014 European Association of Urology, Published by Elsevier B.V.