Local and systemic morbidities of de novo metastatic prostate cancer in Singapore: insight from 685 consecutive patients from a large prospective Uro-oncology registry

Abstract

ObjectiveTo evaluate the incidence and management of local and systemic complications afflicting patients with de novo metastatic prostate cancer (mPCa) in Singapore.DesignRetrospective analysis of a large prospective Uro-oncology registry of mPCa.SettingThis study is carried out in a tertiary hospital in Singapore.ParticipantsWe reviewed our institution’s prospectively maintained database of 685 patients with mPCa over a 20-year period (1995–2014). Patients with non-mPCa or those progressed to metastatic disease after previous curative local treatments were excluded.Primary and secondary outcome measuresThe primary outcome was to evaluate the systemic and local morbidity rates associated with mPCa. Local complication was defined as the need for palliative procedures to relieve urinary obstruction, worsening renal function or refractory haematuria, while systemic complication was related to radiographic evidence of skeletal-related pathological fractures. Secondary outcomes analysed were the management and overall survival patterns over 20 years.Results237 (34.6%) patients required local palliative treatments. 88 (12.8%) patients presented with acute urinary retention, 23 patients (9.7%) required repetitive local palliative treatments. On multivariate analyses, prostate-specific antigen >100 (p=0.02) and prostate volume >50 g (p=0.03) were independent prognostic factors for significant obstruction requiring palliative procedures. 118 (17.2%) patients developed skeletal fractures, with poor Eastern Cooperative Oncology Group Performance (ECOG) status (p=0.01) and high volume bone metastasis (p<0.01) independently predictive of skeletal fractures. Altogether, 653 (95.3%) patients received androgen deprivation therapy (ADT), with the median time to castrate resistance of 21.4 months (IQR 7–27). The median overall survival was 45 months (IQR 20–63), with prostate cancer mortality of 81.4%. Improved overall survival was observed from 41.6 months (1995–1999) to 47.8 months (2010–2014) (p<0.01).ConclusionMorbidities and complications arising from mPCa are more common and debilitating than we thought, often requiring immediate palliative treatments, while many necessitate repeated interventions with progression.

Far from the truth: Real‐world treatment patterns among newly diagnosed metastatic prostate cancer in the era of treatment intensification

“…Patients would benefit from more convenient care with less fragmentation. Furthermore, urologists can manage local complications of prostate cancer and coordinate care for systemic complications when they arise 27 . However, few urologists prescribe chemotherapy because they lack expertise in administering chemotherapy and managing its associated toxicities.…”

“…Furthermore, urologists can manage local complications of prostate cancer and coordinate care for systemic complications when they arise. 27 However, few urologists prescribe chemotherapy because they lack expertise in administering chemotherapy and managing its associated toxicities. The role of the urologist has expanded owing to the addition of NHA as one of therapeutic options for mHSPC.…”

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC): Advances and Treatment Strategies in the First-Line Setting

“…Prostate cancer is predominantly a disease of the elderly, with peak incidence in men occurring at an age of just above 70 years. The median age of presentation of de novo metastatic prostate cancer based on registry data is 73-76 years [24][25][26], which is significantly higher than the age of the men recruited in all of the clinical trials. More than 90% of patients with prostate cancer are diagnosed with localised disease, at an average age of 66 years [27].…”

Palliative Urologische Chirurgie des metastasierten Prostatakarzinoms: was müssen wir zukünftig berücksichtigen?

“…Ungefähr 10% der Patienten bedürfen einer erneuten operativen Intervention wegen eines neuerlichen symptomatischen Tumorrezidivs. Allen publizierten Serien gemeinsam ist die Tatsache, dass 10-15% der Patienten eine dauerhafte transurethrale oder suprapubische Katheterableitung aufgrund rezidivierender Harnverhaltungen oder einer postoperativen Inkontinenz bedürfen [24]. Selbst in erfahrenen Händen ist die pTURP mit einer höheren Komplikationsrate verbunden als die klassische TURP.…”