MAAUA: 2007 Abstracts - The Natural History of Men Managed with Deferred Hormonal Therapy Who Developed Metastatic Prostate Cancer Following Radical Prostatectomy

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The Natural History of Men Managed with Deferred Hormonal Therapy Who Developed Metastatic Prostate Cancer Following Radical Prostatectomy
Danil V Makarov, Bruce J. Trock, Elizabeth B. Humphreys, Leslie A. Mangold, Michael A. Carducci, Alan W. Partin, Mario A. Eisenberger, Patrick C. Walsh
Johns Hopkins University School of Medicine, Baltimore, MD

Introduction: We evaluated factors influencing prostate cancer (CaP) specific mortality (PCSM) at the time of metastasis in a cohort of hormone naïve, PSA-era patients developing metastases after radical prostatectomy (RP) followed closely and treated with deferred androgen deprivation therapy (ADT) at metastasis.
Methods: 3,096 men had RP by one surgeon at Johns Hopkins Hospital from 1987-2005. 422 had PSA failure. 123 developed distant metastasis, of whom 91 with complete data formed the study cohort: initially treated during the PSA-era (1987-2005) and receiving ADT after documented metastasis. 41 died of CaP. Median survival times were estimated by Kaplan-Meier analysis. Prognostic impact was estimated as the hazard ratio (HR) derived from the Cox proportional hazards model.
Results: Median (range) followup from RP was 10years (2-18). Actuarial median (range) times to failure are: 2years (1-12) from RP to PSA failure, 3years (0-11) from PSA failure to metastasis, 7years (1-15) from metastasis to death, and 14years (2-18) from RP to death. The following were significant univariate predictors of PCSM at the time of metastasis: pain at diagnosis of metastases (p<0.01), time from RP to metastasis (p=0.02), and PSADT<3months during the 2years prior to metastasis (p<0.01). Multivariable analysis demonstrated the following independent predictors of PCSM at the time of metastasis: pain (HR=7.9 p<0.01) and PSADT<3months (HR=4.6 p<0.01).
Conclusions: The presence of pain and PSADT predicted the outcome of hormone naïve men receiving deferred ADT for the development of metastasis after RP. Men treated with deferred ADT may have a long lifespan, 14years post-RP (range2-18).

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