AUTHOR=Wenzel Mike , Preisser Felix , Hoeh Benedikt , Schroeder Maria , Würnschimmel Christoph , Steuber Thomas , Heinzer Hans , Banek Severine , Ahrens Marit , Becker Andreas , Karakiewicz Pierre I. , Chun Felix K. H. , Kluth Luis A. , Mandel Philipp 

TITLE=Impact of Time to Castration Resistance on Survival in Metastatic Hormone Sensitive Prostate Cancer Patients in the Era of Combination Therapies

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.659135

DOI=10.3389/fonc.2021.659135

ISSN=2234-943X

ABSTRACT=Background: 
To evaluate the impact of time to castration resistance (TTCR) in metastatic hormone-sensitive prostate cancer (mHSPC) patients on overall survival (OS) in the era of combination therapies for mHSPC.
Material and Methods:
Of 213 mHSPC patients diagnosed between 01/2013-12/2020 who subsequently developed metastatic castration resistant prostate cancer (mCRPC) 204 eligible patients were analyzed after having applied exclusion criteria. mHSPC patients were classified into TTCR <12 vs. 12-18 vs. 18-24 vs. >24 months and analyzed regarding OS. Moreover, further OS analyses were performed after having developed mCRPC status according to TTCR. Logistic regression models predicted the value of TTCR on OS.
Results:
Median follow-up was 34 months. Among 204 mHSPC patients, 41.2% harbored TTCR <12 months vs. 18.1% 12-18 months vs. 15.2% 18-24 months vs. 25.5% >24 months. Median age was 67 years and median PSA at prostate cancer diagnosis was 61 ng/ml. No differences in patient characteristics were observed (all p>0.05). According to OS, TTCR <12 months patients had the worst OS, followed by TTCR 12-18 months, 18-24 months and >24 months, in that order (p<0.001). After multivariable adjustment, a 4.07-, 3.31- and 6.40-fold higher mortality was observed for TTCR 18-24 months, 12-18 months and <12 months patients, relative to TTCR >24 months (all p<0.05). Conversely, OS after development of mCRPC was not influenced by TTCR stratification (all p>0.05).
Conclusion: 
Patients with TTCR <12 months are at the highest OS disadvantage in mHSPC. This OS disadvantage persisted even after multivariable adjustment. Interestingly, TTCR stratified analyses did not influence OS in mCRPC patients.