Locoregional symptoms in patients with de novo metastatic prostate cancer: Morbidity, management, and disease outcome.
BACKGROUND
The paradigm change observed over the last few years in several solid tumors emphasizes the value of locoregional treatment in the presence of metastatic disease, currently ignored in de novo prostate cancer (CaP). We investigated the effect of the primary tumor that is left untreated on prostate cancer-specific morbidity and mortality, time to castration resistance, and overall survival (OS).


METHODS
We performed a bicentric cohort study. The overall population included de novo metastatic CaP managed at the Genito-Urinary Oncology Unit of the Gustave Roussy Institute and the Urology Clinic of the University Hospital of Pointe-à-Pitre, France. Descriptive statistical and outcome analyses were performed in the overall cohort and also separately in the N+M0 and M+subgroups.


RESULTS
The overall cohort included 263 patients. Approximately two-thirds of patients (64%) presented with locoregional symptoms at diagnosis, and 78% throughout the disease. Of the symptomatic patients, 59% required a locoregional procedure. Median OS of patients with locoregional symptoms at diagnosis was shorter than in those who were asymptomatic (47 vs. 86 mo, P = 0.0007); this difference was maintained in the N+M0 and M+subgroups. Median OS and time to castration resistance showed a nonsignificant trend in favor of patients undergoing a locoregional treatment at diagnosis.


CONCLUSIONS
The presence of symptoms due to locoregional disease in de novo metastatic CaP entails significant morbidity and even mortality and requires active management. Randomized prospective trials are needed to evaluate the role of initial definite locoregional treatment in these patients.
Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Anna
A
Patrikidou
Department of Urology, University Hospital of Pointe-à-Pitre, France.
Laurent
L
Brureau
Department of Urology, University Hospital of Pointe-à-Pitre, France.
Julien
J
Casenave
Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Laurence
L
Albiges
Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Mario
M
Di Palma
Department of Urology, Kremlin-Bicêtre Hospital, University of Paris-Sud, Kremlin-Bicêtre, France.
Jean-Jacques
JJ
Patard
Department of Urology, Saint-Joseph Hospital, Paris, France.
Hervé
H
Baumert
Department of Radiotherapy, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Pierre
P
Blanchard
Department of Radiotherapy, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Alberto
A
Bossi
Department of Forestry and Management of the Environment and Natural Resources, School of Agricultural Sciences and Forestry, Democritus University, Alexandroupoli, Greece.
Kyriaki
K
Kitikidou
Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Christophe
C
Massard
Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France.
Karim
K
Fizazi
Department of Urology, University Hospital of Pointe-à-Pitre, France.
Pascal
P
Blanchet
Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, Villejuif, France. Electronic address: yohann.loriot@gustaveroussy.fr.
Yohann
Y
Loriot
D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D016896:Treatment Outcome
Locoregional symptoms; Locoregional treatment; Metastatic prostate cancer; Morbidity; Outcomes assessment