Comparison of Oncological Results of Patients who Developed Systemic Metastasis After Radical Prostatectomy and Patients Receiving Androgen Deprivation Treatment due to Primary Systemic Metastatic Disease

INTRODUCTION: In this study, we aimed to compare the overall survival and the time until castration resistance developed between the patients who developed systemic metastasis after radical prostatectomy and who started androgen deprivation therapy (ADT) and those who started ADT due to primary systemic metastasis.
METHODS: In our clinic, between 2009 and 2017, we compared 61 patients who have metastatic prostate cancer at the time of diagnosis and ADT was initiated primarily and 28 patients who developed systemic metastasis after radical prostatectomy and after ADT was initiated, in terms of the overall survival, development status of castration resistance, the duration of development to castration resistance, and prostate specific antigen (PSA) changes in follow-up retrospectively. LHRH agonist + antiandrogen (for only 1 month) therapy was started immediately after diagnosis in ADT group (Group 1). In the radical prostatectomy group (Group 2), LHRH agonist + antiandrogen therapy (1 month) was initiated due to PSA elevation or developing systemic metastasis.
RESULTS: In the study, at Group 1, the age of patients (69.18±7.7 vs. 64.21±5.03, p=0.001), PSA values before biopsy (7508.24±26406.98 vs. 21.24±19.62, p=0.001), and total gleason score mean (p=0.001) were significantly higher than Group 2. Between two groups There was no significant different in terms of the rate of development to castration resistance (49.2%vs. 39.3%, p=0.38), time to castration resistance (46.8 months vs. 48.9 months, p=0.068), and overall survival (130.48 months vs. 97.43 months, p=0.207).
DISCUSSION AND CONCLUSION: In our study, if radical prostatectomy was performed before systemic metastasis developed, there was no difference in terms of castration resistance development, time to castration resistance, and overall survival with primarily metastatic disease.