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Abstract

PURPOSE:

There is growing interest in the role of local therapies, including external beam radiotherapy (RT), for men with metastatic prostate cancer (mPCa). We used the National Cancer Database (NCDB) to evaluate the overall survival (OS) of men with mPCa treated with androgen deprivation (ADT) with and without prostate RT.

METHODS:

The NCDB was queried for men with newly diagnosed mPCa, all treated with ADT, with complete datasets for RT, surgery, prostate-specific antigen (PSA) level, Gleason score, and Charlson-Deyo comorbidity score. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses.

RESULTS:

From 2004 to 2012, 6,382 men with mPCa were identified, including 538 (8.4%) receiving prostate RT. At a median follow-up of 5.1 years, the addition of prostate RT to ADT was associated with improved OS on univariate (P < .001) and multivariate analysis (hazard ratio, 0.624; 95% CI, 0.551 to 0.706; P < .001) adjusted for age, year, race, comorbidity score, PSA level, Gleason score, T stage, N stage, chemotherapy administration, treating facility, and insurance status. Propensity score analysis with matched baseline characteristics demonstrated superior median (55 v 37 months) and 5-year OS (49% v 33%) with prostate RT plus ADT compared with ADT alone (P < .001). Landmark analyses limited to long-term survivors of ≥1, ≥3, and ≥5 years demonstrated improved OS with prostate RT in all subsets (all P < .05). Secondary analyses comparing the survival outcomes for patients treated with therapeutic dose RT plus ADT versus prostatectomy plus ADT during the same time interval demonstrated no significant differences in OS, whereas both therapies were superior to ADT alone.

CONCLUSION:

In this large contemporary analysis, men with mPCa receiving prostate RT and ADT lived substantially longer than men treated with ADT alone. Prospective trials evaluating local therapies for mPCa are warranted. 

Author information​

Rusthoven CG1, Jones BL2, Flaig TW2, Crawford ED2, Koshy M2, Sher DJ2, Mahmood U2, Chen RC2, Chapin BF2, Kavanagh BD2, Pugh TJ2.

1Chad. G. Rusthoven, Bernard L. Jones, Thomas W. Flaig, E. David Crawford, Brian D. Kavanagh, and Thomas J. Pugh, University of Colorado School of Medicine, Aurora, CO; Matthew Koshy, University of Illinois at Chicago School of Medicine; Matthew Koshy, The University of Chicago School of Medicine, Chicago, IL; David J. Sher, University of Texas Southwestern, Dallas; Usama Mahmood and Brian F. Chapin University of Texas, MD Anderson Cancer Center, Houston, TX; and Ronald C. Chen University of North Carolina at Chapel Hill, Chapel Hill, NC. chad.rusthoven@ucdenver.edu.

2Chad. G. Rusthoven, Bernard L. Jones, Thomas W. Flaig, E. David Crawford, Brian D. Kavanagh, and Thomas J. Pugh, University of Colorado School of Medicine, Aurora, CO; Matthew Koshy, University of Illinois at Chicago School of Medicine; Matthew Koshy, The University of Chicago School of Medicine, Chicago, IL; David J. Sher, University of Texas Southwestern, Dallas; Usama Mahmood and Brian F. Chapin University of Texas, MD Anderson Cancer Center, Houston, TX; and Ronald C. Chen University of North Carolina at Chapel Hill, Chapel Hill, NC.