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The following is a summary of “Impact of time to metastatic disease onset and extent of disease volume across metastatic hormone-sensitive and castration-resistant prostate cancer,” published in the August 2024 issue of Urology by Wenzel et al.

Recent phase III trials have highlighted differences in overall survival (OS) between patients with secondary versus de novo metastatic hormone-sensitive prostate cancer (mHSPC) and those with low versus high disease volume. This study aims to investigate whether these factors similarly influence outcomes in a real-world setting, particularly with the advent of intensified combination therapies and in the context of metastatic castration-resistant prostate cancer (mCRPC).

Researchers utilized an institutional tertiary-care database to identify patients with mHSPC who progressed to mCRPC. The primary outcomes analyzed were time to progression to mCRPC and OS. Patients were categorized based on their initial presentation as de novo versus secondary and by disease volume as low versus high, both in the mHSPC and mCRPC stages.

Among 504 patients with mHSPC, 371 (73.6%) were classified as de novo and 133 (26.4%) as secondary. Patients with de novo high-volume mHSPC had significantly shorter progression to mCRPC and reduced OS than those with secondary and low-volume mHSPC (P < 0.01). When stratified by disease volume, the median time to progression to mCRPC was notably different among the groups: de novo high-volume (DNHV), de novo low-volume (DNLV), secondary high-volume (SecHV), and secondary low-volume (SecLV) mHSPC patients (P < 0.001). Similarly, the median OS was 44 months for DNHV, 53 months for SecHV, 88 months for SecLV, and 120 months for patients with DNLV mHSPC (P < 0.001). These differences persisted even after progression to mCRPC, with time to mCRPC and disease volume continuing to affect outcomes (all P < 0.01) significantly.

Patients with de novo high-volume mHSPC demonstrate a worse prognosis in real-world settings, even with the use of advanced combination therapies. This adverse effect remains evident when these patients progress to mCRPC. These findings underscore the need for tailored treatment strategies based on disease presentation and volume to improve patient outcomes.

Source: sciencedirect.com/science/article/pii/S107814392400526X