Risk Assessment Among Prostate Cancer Patients Receiving Primary Androgen Deprivation Therapy

Purpose Prostate cancer epidemiology has been marked overall by a downward risk migration over time. However, in some populations, both in the United States and abroad, many men are still diagnosed with high-risk and/or advanced disease. Primary androgen deprivation therapy (PADT) is frequently offered to these patients, and disease risk prediction is not well-established in this context. We compared risk features between large disease registries from the United States and Japan, and aimed to build and validate a risk prediction model applicable to PADT patients. Methods Data were analyzed from 13,740 men in the United States community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry and 19,265 men in the Japan Study Group of Prostate Cancer (J-CaP) database, a national Japanese registry of men receiving androgen deprivation therapy. Risk distribution was compared between the two datasets using three well-described multivariable instruments. A novel instrument (Japan Cancer of the Prostate Risk Assessment [J-CAPRA]) was designed and validated to be specifically applicable to PADT patients, and more relevant to high-risk patients than existing instruments. Results J-CaP patients are more likely than CaPSURE patients to be diagnosed with high-risk features; 43% of J-CaP versus 5% of CaPSURE patients had locally advanced or metastatic disease that could not be stratified with the standard risk assessment tools. J-CAPRA—scored 0 to 12 based on Gleason score, prostate-specific antigen level, and clinical stage—predicts progression-free survival among PADT patients in J-CaP with a c-index of 0.71, and cancer-specific survival among PADT patients in CaPSURE with a c-index of 0.84. Conclusion The novel J-CAPRA is the first risk instrument developed and validated for patients undergoing PADT. It is applicable to those with both localized and advanced disease, and performs well in diverse populations.

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A single-center study on predicting outcomes of primary androgen deprivation therapy for prostate cancer using the Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyu186 ◽

2014 ◽

Vol 45 (2) ◽

pp. 197-201 ◽

Cited By ~ 6

Author(s):

Y. Yamaguchi ◽

Y. Hayashi ◽

Y. Ishizuya ◽

K. Takeda ◽

Y. Nakai ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Assessment ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Single Center ◽

Primary Androgen Deprivation Therapy ◽

Single Center Study ◽

Cancer Of The Prostate ◽

Center Study ◽

Primary Androgen Deprivation

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Trends in Androgen Deprivation Therapy Use With Radiation for Intermediate- and High-Risk Prostate Cancer Across the United States

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.07.109 ◽

2015 ◽

Vol 93 (3) ◽

pp. S45

Author(s):

A. Falchook ◽

J.J. Mohiuddin ◽

R.C. Chen

Keyword(s):

Prostate Cancer ◽

United States ◽

High Risk ◽

Androgen Deprivation Therapy ◽

The United States ◽

Androgen Deprivation ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Use of Androgen Deprivation Therapy With Radiotherapy for Intermediate- and High-Risk Prostate Cancer Across the United States

JAMA Oncology ◽

10.1001/jamaoncol.2016.1143 ◽

2016 ◽

Vol 2 (9) ◽

pp. 1236 ◽

Cited By ~ 9

Author(s):

Aaron D. Falchook ◽

Ramsankar Basak ◽

Jahan J. Mohiuddin ◽

Ronald C. Chen

Keyword(s):

Prostate Cancer ◽

United States ◽

High Risk ◽

Androgen Deprivation Therapy ◽

The United States ◽

Androgen Deprivation ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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PCN194 Prevalence of Major Adverse Cardiac Events (MACE) in Patients with Prostate Cancer (PC) Receiving Androgen Deprivation Therapy (ADT) in the United States

Value in Health ◽

10.1016/j.jval.2020.08.331 ◽

2020 ◽

Vol 23 ◽

pp. S457

Author(s):

B. Brady ◽

J. Pruett ◽

I. Winer ◽

D. van Veenhuyzen ◽

R. Dufour

Keyword(s):

Prostate Cancer ◽

United States ◽

Androgen Deprivation Therapy ◽

The United States ◽

Androgen Deprivation ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events

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Low Utilization of Androgen Deprivation Therapy Among Men Receiving Stereotactic Body Radiotherapy for Localized Prostate Cancer in the United States

European Urology Oncology ◽

10.1016/j.euo.2020.06.006 ◽

2020 ◽

Author(s):

Trevor J. Royce ◽

Jeffrey M. Switchenko ◽

Chao Zhang ◽

Daniel E. Spratt ◽

Ronald C. Chen ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Androgen Deprivation Therapy ◽

Stereotactic Body Radiotherapy ◽

The United States ◽

Androgen Deprivation ◽

Localized Prostate Cancer

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Prevalence of Patients With Nonmetastatic Prostate Cancer on Androgen Deprivation Therapy in the United States

Urology ◽

10.1016/j.urology.2013.02.050 ◽

2013 ◽

Vol 81 (6) ◽

pp. 1184-1189 ◽

Cited By ~ 10

Author(s):

Karynsa Cetin ◽

Shuling Li ◽

Anne H. Blaes ◽

Scott Stryker ◽

Alexander Liede ◽

...

Keyword(s):

Prostate Cancer ◽

United States ◽

Androgen Deprivation Therapy ◽

The United States ◽

Androgen Deprivation

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Trans-Pacific variation in outcomes for men treated with primary androgen deprivation therapy for localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.92 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 92-92

Author(s):

Matthew R. Cooperberg ◽

Shiro Hinotsu ◽

Mikio Namiki ◽

Peter Carroll ◽

Hideyuki Akaza

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

The United States ◽

Androgen Deprivation ◽

Localized Prostate Cancer ◽

Primary Androgen Deprivation Therapy ◽

The Pacific ◽

Treatment Type ◽

The Us ◽

Primary Androgen Deprivation

92 Background: Primary androgen deprivation therapy (PADT) is endorsed as an option for monotherapy for localized prostate cancer by guidelines in Asia but not in the United States (US) or Europe. PADT use is common, however, in both the US and Japan. Prior studies on either side of the Pacific have reported disparate outcomes for PADT; we aimed to explore these differences in a direct comparison study. Methods: Data were drawn from the US community-based CaPSURE registry and from J-CaP, comprising men in Japan treated with PADT. 1934 men treated with PADT were included from CaPSURE, and 16,300 treated in J-CaP. Risk adjustment was based on the validated Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score. Cox proportional hazards regression was used to assess prostate cancer-specific mortality (CSM), adjusting for age, J-CAPRA, year of diagnosis, and treatment type (combined androgen blockade [CAB] vs. castration (medical or surgical) monotherapy). Results: Men treated with PADT in J-CaP were older than those in CaPSURE (mean age 75.0 vs. 72.7, p<0.001), and had higher risk disease (mean J-CAPRA score 3.0 vs. 2.1, p<0.001). They were more likely to be treated with CAB: 67.1% vs. 44.5% (p<0.001). In the Cox model, the hazard ratio (HR) for PCSM was 0.31 for J-CaP compared to CaPSURE, 95% CI 0.25–0.40. In J-CaP, CAB improved survival compared to castration alone (HR 0.81, 95% CI 0.66–1.0), but this effect was not observed in CaPSURE (HR 0.96, 95% CI 0.69–1.34). For all-cause mortality, the HR for J-CaP was 0.27 (95% CI 0.24–0.30). Conclusions: Adjusting for multiple factors including disease risk and type of androgen ablation, men treated with PADT in Japan compared to the US have more than 3-fold lower CSM and 4-fold better overall survival. CAB improved outcomes compared to castration alone in J-CaP but not in CaPSURE. These findings support existing guidelines both encouraging PADT in Asia and discouraging its use in the West. The reasons for these substantial differences likely include both genetic and dietary/environmental factors, as well as potential confounding variables such as comorbidities. Such factors may explain varying biology of prostate cancer on both sides of the Pacific.

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