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Platinum Priority – Prostate Cancer
Editorial by Howard I. Scher on pp. 1039–1041 of this issue

Survival with Newly Diagnosed Metastatic Prostate Cancer in the “Docetaxel Era”: Data from 917 Patients in the Control Arm of the STAMPEDE Trial (MRC PR08, CRUK/06/019)

By: Nicholas David James a lowast , Melissa R. Spears b , Noel W. Clarke c , David P. Dearnaley d e , Johann S. De Bono d e , Joanna Gale f , John Hetherington g , Peter J. Hoskin h , Robert J. Jones i , Robert Laing j , Jason F. Lester k , Duncan McLaren l , Christopher C. Parker d e , Mahesh K.B. Parmar b , Alastair W.S. Ritchie b , J. Martin Russell m , Räto T. Strebel n , George N. Thalmann o , Malcolm D. Mason k and Matthew R. Sydes b

European Urology, Volume 67 Issue 6, June 2015, Pages 1028-1038

Published online: 01 June 2015

Keywords: Prostate cancer, Natural history, Survival, Time to progression, Control arm cohort, Hormone-naïve, Metastatic, Prognostic factors, Prospective data

Abstract Full Text Full Text PDF (1,7 MB) Patient Summary

Abstract

Background

Prostate cancer (PCa) is the second most common disease among men worldwide. It is important to know survival outcomes and prognostic factors for this disease. Recruitment for the largest therapeutic randomised controlled trial in PCa—the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy: A Multi-Stage Multi-Arm Randomised Controlled Trial (STAMPEDE)—includes men with newly diagnosed metastatic PCa who are commencing long-term androgen deprivation therapy (ADT); the control arm provides valuable data for a prospective cohort.

Objective

Describe survival outcomes, along with current treatment standards and factors associated with prognosis, to inform future trial design in this patient group.

Design, setting, and participants

STAMPEDE trial control arm comprising men newly diagnosed with M1 disease who were recruited between October 2005 and January 2014.

Outcome measurements and statistical analysis

Overall survival (OS) and failure-free survival (FFS) were reported by primary disease characteristics using Kaplan-Meier methods. Hazard ratios and 95% confidence intervals (CIs) were derived from multivariate Cox models.

Results and limitations

A cohort of 917 men with newly diagnosed M1 disease was recruited to the control arm in the specified interval. Median follow-up was 20 mo. Median age at randomisation was 66 yr (interquartile range [IQR]: 61–71), and median prostate-specific antigen level was 112 ng/ml (IQR: 34–373). Most men (n = 574; 62%) had bone-only metastases, whereas 237 (26%) had both bone and soft tissue metastases; soft tissue metastasis was found mainly in distant lymph nodes. There were 238 deaths, 202 (85%) from PCa. Median FFS was 11 mo; 2-yr FFS was 29% (95% CI, 25–33). Median OS was 42 mo; 2-yr OS was 72% (95% CI, 68–76). Survival time was influenced by performance status, age, Gleason score, and metastases distribution. Median survival after FFS event was 22 mo. Trial eligibility criteria meant men were younger and fitter than general PCa population.

Conclusions

Survival remains disappointing in men presenting with M1 disease who are started on only long-term ADT, despite active treatments being available at first failure of ADT. Importantly, men with M1 disease now spend the majority of their remaining life in a state of castration-resistant relapse.

Patient summary

Results from this control arm cohort found survival is relatively short and highly influenced by patient age, fitness, and where prostate cancer has spread in the body.

Take Home Message

Data from the control arm of the STAMPEDE trial show that survival remains poor, particularly for younger men with bony metastatic prostate cancer. Men spend substantial time in a castration-resistant relapse state. New approaches are urgently needed. These data will help plan new randomised comparisons in this setting.

Keywords: Prostate cancer, Natural history, Survival, Time to progression, Control arm cohort, Hormone-naïve, Metastatic, Prognostic factors, Prospective data.

Footnotes

a University of Warwick, Coventry, UK

b Medical Research Council Clinical Trials Unit at University College London, London, UK

c Department of Urology, The Christie NHS Foundation Trust, Manchester, UK

d Institute of Cancer Research, London, UK

e The Royal Marsden NHS Foundation Trust, London and Sutton, UK

f Queen Alexandra Hospital, Portsmouth, UK

g Hull & East Yorkshire Hospitals NHS Trust, Hull, UK

h Mount Vernon Hospital, Northwood, Middlesex, UK

i University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK

j Royal Surrey County Hospital, Guildford, UK

k Velindre Hospital, Cardiff, UK

l Western General Hospital, Edinburgh, UK

m Institute of Cancer Sciences, University of Glasgow, Glasgow, UK

n Kantonsspital Graübunden, Chur, Switzerland

o Department of Urology, University Hospital, Bern, Switzerland

lowast Corresponding author. Nicholas David James, University of Warwick, Cancer Research Unit, Warwick Medical School, Coventry, Warwickshire, CV4 7AL, UK. Tel. +44 7801356318.

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