A meta-analysis of two randomized STAMPEDE platform trials revealed that 3 yr of abiraterone acetate in addition to androgen deprivation therapy and radiation therapy significantly improved metastasis-free and overall survival (OS) in high-risk nonmetastatic prostate cancer (PCa) and should be considered a new standard of care. The aim of our study was to assess long-term cancer-specific survival (CSS) and OS for surgically treated patients with newly diagnosed nonmetastatic node-negative PCa meeting the STAMPEDE criteria for high risk.
This was a retrospective, multicenter cohort study of patients with European Association of Urology (EAU) high-risk PCa who underwent radical prostatectomy and extended pelvic lymph node dissection. CSS was assessed using cumulative incidence curves and the Kaplan-Meier method was used to evaluate OS. We used a Fine and Gray model to evaluate the prognostic value of STAMPEDE high-risk factors (SHRFs) for CSS, and a Cox proportional-hazards model to assess the association of SHRFs with OS.
A total of 2994 patients with EAU high-risk PCa were divided into groups with 0, 1, 2, or 3 SHRFs. The 10-yr survival estimates for patients with 0-1 versus 2-3 SHRFs were 95% versus 82% for CSS and 81% versus 64% for OS (both p < 0.0001). In comparison to patients with 0 SHRFs, hazard ratios were 1.2 (p = 0.5), 3.9 (p < 0.0001), and 5.5 (p < 0.0001) for CSS, and 1.1 (p = 0.4), 2.2 (p < 0.0001), and 2.5 (p = 0.0004) for OS for patients with 1, 2, and 3 SHRFs, respectively.
Our results confirm that the STAMPEDE high-risk criteria identify a subgroup of patients with highly aggressive PCa features and adverse long-term oncological outcomes. This population is likely to benefit most from aggressive multimodal treatment. Nevertheless, we have shown for the first time that surgery remains a viable treatment option for patients with STAMPEDE high-risk PCa.
Prostate cancer that meets the high-risk definitions from the STAMPEDE trial is an aggressive type of cancer. Our results for long-term cancer control outcomes indicate that surgery is a viable option for the subgroup of patients with this type of prostate cancer.
European urology oncology. 2024 Jul 11 [Epub ahead of print]
Daimantas Milonas, Alexander Giesen, Annouschka Laenen, Gaëtan Devos, Alberto Briganti, Paolo Gontero, R Jeffrey Karnes, Piotr Chlosta, Frank Claessens, Gert De Meerleer, Wouter Everaerts, Markus Graefen, Giansilvio Marchioro, Rafael Sanchez-Salas, Bertrand Tombal, Henk Van Der Poel, Hendrik Van Poppel, Martin Spahn, Steven Joniau, European Multicenter Prostate Cancer Clinical and Translational Research Group (EMPaCT)
Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, Lithuanian University of Health Sciences, Kaunas, Lithuania., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium., KU Leuven Biostatistics and Statistical Bioinformatics Center, Leuven, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, University Vita Salute, San Raffaele Hospital, Milan, Italy., Department of Urology, University of Turin, A.O.U. San Giovanni Battista-le Molinette, Turin, Italy., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, Jagiellonian University Medical College, Krakow, Poland., Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium., Martini Klinik am UKE GmbH, Hamburg, Germany., Department of Urology, University of Piemonte Orientale, Novara, Italy., Department of Urology, McGill University, Montreal, Canada., Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Lindenhofspital Bern, Bern, Switzerland., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium. Electronic address: .