3489 - Overall Survival (OS) and Metastasis-Free Survival (MFS) in men with Biochemically Relapsed (BCR) Prostate Cancer after radical prostatectomy (RP) managed with deferred Androgen Deprivation Treatment (ADT): A combined Johns Hopkins and CPDR study

Background

ADT prior to mets may not improve QoL or OS in BCR prostate cancer and may result in irreversible adverse events at high costs. Early use of novel androgen receptor targeting drugs (NARTD) prolonged MFS in nonmetastatic-castration resistant prostate cancer (nmCRPC). However, clinical details prior to castration resistance and explicit criteria for starting ADT were not given. We hypothesize that deferring ADT until mets results in outcomes comparable to those reported with early ADT, irrespective of NARTD used in nmCRPC.

Methods

Retrospective review of men who underwent RP from1983 - 2014 within Johns Hopkins and the Center for Prostate Disease Research Multi-Center National Database, developed BCR and did not receive ADT until metastasis. Kaplan-Meier estimates of MFS and OS were defined from RP to event/last follow-up. Multivariable Cox proportional hazard models identified predictive factors.

Results

2,930 men fulfilled eligibility criteria: median age 61,17% African American, Gleason 6 (29%),7 (52%), 8-10 (18%), + margins 38%, median PSADT 27 mos. With a median F/U of 10 years, 20% developed M+ and received ADT, 27% died. Median MFS was 24 yrs (21-27 yrs) and median OS was 21 yrs (20-22 yrs) (Table). Age at surgery, pT stage, Gleason sum, surgical margin status and PSADT significantly predicted OS (p<.03). pT stage, Gleason sum, time to BCR, race and PSADT predicted MFS (p < 0.01).Table:

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Conclusions

Deferred ADT until time of metastases results in long MFS and OS even with short PSADT suggesting that it remains possible that prolongation of MFS in nmCRPC may not reflect true overall net therapeutic benefits which requires prospective study to define specific patient selection and criteria for initial ADT implementation, control of post progression management and QoL/OS information.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

C.H. Marshall: Research grant / Funding (self): Conquer Cancer Foundation (Bristol Meyers Squibb); Travel / Accommodation / Expenses: Dava Oncology; Advisory / Consultancy: McGraw Hill. B. Trock: Advisory / Consultancy, Research grant / Funding (institution): Myriad Genetics; Research grant / Funding (institution): MDx Health. All other authors have declared no conflicts of interest.