Efficacy of combined androgen blockade therapy in patients with metastatic hormone-sensitive prostate cancer stratified by tumor burden.

Abstract

OBJECTIVE:

To determine the effect of combined androgen blockade with a first-generation anti-androgen on the prognoses of metastatic hormone-sensitive prostate cancer patients stratified by tumor burden.

METHODS:

We retrospectively analyzed the cases of metastatic hormone-sensitive prostate cancer patients who were treated with androgen deprivation therapy in 2008-2017 at 30 institutions in Japan. To compare the overall survival and progression-free survival rates of the patients treated with castration monotherapy and combined androgen blockade, we carried out a Cox proportional hazards regression analysis using both inverse probability of treatment weighting and instrumental variables methods. High-burden disease was defined as the presence of four or more bone metastases and/or visceral metastasis.

RESULTS:

Of 2048 patients, 702 (34.3%) and 1346 (65.7%) patients were classified as the low- and high-burden groups, respectively. In each group, >80% of the patients were treated with combined androgen blockade. Although there was no significant between-group difference in the overall survival according to the androgen deprivation therapy method, in the high-burden group the progression-free survival of the combined androgen blockade-treated patients was significantly better than that of patients treated with castration monotherapy: inverse probability of treatment weighting method, hazard ratio 0.49, 95% confidence interval 0.34-0.71; instrumental variables method, hazard ratio 0.80, 95% confidence interval 0.60-0.98.

CONCLUSION:

In the high-burden group, combined androgen blockade with a first-generation anti-androgen resulted in superior progression-free survival compared with castration monotherapy. For well-selected metastatic hormone-sensitive prostate cancer patients, the use of combined androgen blockade might still have some suitable scenarios.

• Authors: Yoshiyuki Nagumo, Mizuki Onozawa, Takahiro Kojima, Naoki Terada, Masaki Shiota, Koji Mitsuzuka, Hiroaki Yasumoto, Hiroaki Matsumoto, Hideki Enokida, Takayuki Sugiyama, Kentaro Kuroiwa, Toshihiro Saito, Akira Yokomizo, Naoki Kohei, Ken-Ichi Tabata, Atsushi Takahashi, Mikio Sugimoto, Hiroshi Kitamura, Toshiyuki Kamoto, Hiroyuki Nishiyama, Japanese Urological Oncology Group (JUOG)
• Journal: International journal of urology : official journal of the Japanese Urological Association (Int J Urol) Vol. 29 Issue 5 Pg. 398-405 (05 2022) ISSN: 1442-2042 [Electronic] Australia
• PMID: 35080069 (Publication Type: Journal Article)
• Copyright: © 2022 The Japanese Urological Association.

Chemical References

• Androgen Antagonists
• Androgens

Topics

• Androgen Antagonists (therapeutic use)
• Androgens
• Humans
• Male
• Prostatic Neoplasms (drug therapy)
• Retrospective Studies
• Tumor Burden