Prostate cancer: meta-analysis suggests local failure is an independent prognosticator for survival

  • Kishan AU & et al.
  • Eur Urol
  • 10 Nov 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with high-grade localized prostate cancer undergoing radiotherapy, local failure showed independent association with OS, prostate cancer-specific survival (PCSS), and distant metastasis-free survival (DMFS).
  • Local failure before distant metastasis was associated with lower PCSS.

Why this matters

  • Local failure in these patients warrants upfront treatment intensification.

Study design

  • A meta-analysis of 6 randomized studies involving 992 patients with high-grade localized prostate cancer.
  • Funding: None.

Key results

  • Median follow-up was 6.4 years.
  • Local failure was associated with worse OS (HR, 1.70; P<.001 pcss p and dmfs>
  • In patients who received radiotherapy+short-term androgen therapy and experienced distant metastasis, the median time to event was significantly longer in those who had local failure vs those who had not (4.58 vs 2.38 years; P<.01>
  • Patients who had not transitioned to the local failure vs those who transitioned to the local failure state before distant metastasis had a significantly higher PCSS (HR, 0.14; P<.001>
  • Patients who transitioned to the local failure state showed an increased risk for distant metastasis or death (HR, 1.86; P=.04) vs those who did not.

Limitations

  • Heterogeneity across studies.