Improved Overall Survival Trends of Men with Newly Diagnosed M1 Prostate Cancer: A SWOG Phase III Trial Experience (S8494, S8894 and S9346)

Improved Overall Survival Trends of Men with Newly Diagnosed M1 Prostate Cancer: A SWOG Phase III Trial Experience (S8494, S8894 and S9346)

• Catherine M. Tangen
,
• Maha H.A. Hussain
,
• Celestia S. Higano
,
• Mario A. Eisenberger
,
• Eric J. Small
,
• George Wilding
,
• Bryan J. Donnelly
,
• Paul F. Schelhammer
,
• E. David Crawford
,
• Nicholas J. Vogelzang
,
• Isaac J. Powell
,
• Ian M. Thompson Jr.

Received 20 March 2012 published online 23 August 2012.
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Purpose

Frequent prostate specific antigen testing for screening and monitoring prostate cancer has led to significant stage migration. We evaluated whether overall survival in hormone naïve patients with metastatic prostate cancer has improved during the era of prostate specific antigen use. We also assessed whether any patient subsets benefited differentially during this period.

Materials and Methods

We compared overall survival in 3 sequential phase III trials of 3,096 men with hormone naïve, metastatic prostate cancer who received similar androgen deprivation therapy, including 2 trials performed before the prostate specific antigen era (S8494 and S8894) and the other done during this era (S9346). Overall survival was adjusted for patient and disease risk factors in the latter 2 trials. Subgroups were evaluated by interactions of risk factors with trial.

Results

Median overall survival was 30 months in S8494, 33 months in S8894 and 49 months in S9346. Adjusting for risk factors, there was a 22% lower risk of death in S9346 than in S8894 (HR 0.78, 95% CI 0.70, 0.87, p <0 .001=".001" 27="27" 34="34" 35="35" 48="48" 49="49" american="american" and="and" black="black" difference="difference" disappeared="disappeared" for="for" greater="greater" improvement="improvement" in="in" interaction="interaction" median="median" men="men" months="months" nonblack="nonblack" of="of" overall="overall" p="p" racial="racial" respectively.="respectively." s8494="s8494" s8894="s8894" s9346="s9346" survival="survival" test="test" the="the" this="this" was="was" with="with">

Conclusions

Adjusting for risk factors, overall survival was significantly improved in the post-prostate specific antigen era trial. However, it cannot be concluded that this was attributable only to prostate specific antigen monitoring. Black men now have overall survival comparable to that of white men. Current estimates of survival should be used to design new trials in this population.

Key Words:  prostate , prostatic neoplasms , neoplasm metastasis , mortality , prostate-specific antigen

Abbreviations and Acronyms:  AA, black American, ADT, androgen deprivation therapy, M1, metastatic, PS, performance status, PSA, prostate specific antigen