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External beam radiation therapy improves survival in low-volume metastatic prostate cancer patients: a North American population-based study

Prostate Cancer and Prostatic Diseases volume 24, pages 253–260 (2021)Cite this article

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Abstract

Background

We hypothesized that the survival benefit of external beam radiation therapy (EBRT) recorded in European low-volume metastatic prostate cancer (mPCA) patients, will apply to similar North American patients.

Methods

Newly diagnosed mPCa patients with M1a/b substages, treated with EBRT or no EBRT were abstracted from the Surveillance, Epidemiology, and End Results database (2004–2016). Kaplan–Meier plots and Cox-regression models targeted overall mortality (OM) and cancer specific-mortality (CSM) according to EBRT administration. M1 substages and PSA stratified analyses were performed. Internal validation relied on 2000 bootstrap resamples.

Results

Of 15,494 patients, 1156 (7.5%) were M1a vs 14,338 (92.5%) were M1b. PSA at diagnosis ≤10.0 ng/ml was recorded in 1463 (9.4%) patients. In all 15,494 patients, EBRT did not affect OM (hazard ratio [HR] 1.0; p = 0.5). However, in M1a patients and M1b patients with PSA ≤ 10.0 ng/ml EBRT was associated with lower OM (HR 0.73, CI 0.62–0.86; p < 0.001) but not in M1b patients with PSA > 10.0 ng/ml. The PSA cut-off of ≤ 10.0 ng/ml represented the most statistically significant cut-off for OM prediction in M1b patients. Moreover, internal validation with 2000 bootstrap resamples confirmed these findings. Finally, all results were virtually the same, when CSM represented the endpoint of interest.

Conclusions

We validated the OM reduction associated with EBRT in M1a and M1b patients with PSA ≤ 10.0 ng/ml but not in M1b patients with PSA > 10.0 ng/ml. In consequence, it appears that a smaller subset of North American mPCa patients benefit of EBRT than originally reported in European patients. Further North American validation studies are essential.

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Fig. 1: Overall survival of EBRT vs no EBRT treated metastatic prostate cancer patients.
Fig. 2: Overall survival of EBRT vs no EBRT treated M1b substaged prostate cancer patients.
Fig. 3: Overall survival of EBRT vs no EBRT treated M1a substaged patients or M1b patients with PSA ≤ 10.0 ng/ml.
Fig. 4: Overall survival of EBRT vs no EBRT in a subgroup of metastatic prostate cancer pateints.

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Authors and Affiliations

  1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Lara Franziska Stolzenbach, Derya Tilki, Thomas Steuber & Markus Graefen

  2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada

    Lara Franziska Stolzenbach, Marina Deuker, Claudia Collà-Ruvolo, Luigi Nocera, Mila Mansour, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  3. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Marina Deuker & Felix K. H. Chun

  4. Department of Urology, Federico II University of Naples, Naples, Italy

    Claudia Collà-Ruvolo

  5. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Luigi Nocera & Alberto Briganti

Authors
  1. Lara Franziska Stolzenbach
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  13. Pierre I. Karakiewicz
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Contributions

Conceptualization: LFS, PIK. Data curation: LFS, ZT formal analysis: LFS, ZT. Funding acquisition: ---Investigation: LFS, MD, CC-R, LN, and MM. Methodology: LFS, project administration resources. SEER database software R system supervision: PIK validation: ZT, PIK, DT, TS, AB, and FS.

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Correspondence to Lara Franziska Stolzenbach.

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Stolzenbach, L.F., Deuker, M., Collà-Ruvolo, C. et al. External beam radiation therapy improves survival in low-volume metastatic prostate cancer patients: a North American population-based study. Prostate Cancer Prostatic Dis 24, 253–260 (2021). https://doi.org/10.1038/s41391-020-00276-2

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