Long-term outcomes and treatment cessation in patients with response to first-line treatment of metastatic prostate cancer.

BACKGROUND AND

objectiveApproximately one-third of men with metastatic prostate cancer die from causes other than prostate cancer. Little is known about the long-term outcomes of men with metastatic prostate cancer, in particular those who do not develop androgen pathway resistance. The objective of this study is to describe those with long-term survival and disease response to initial therapy and their clinical outcomes.

methodsThis is a single-institution, retrospective study of patients with metastatic hormone-sensitive prostate cancer diagnosed prior to January 1, 2019 and alive as of December 31, 2024. Clinical and demographic features are described at baseline and follow-up, with outcomes after treatment cessation. KEY FINDINGS AND LIMITATIONS: One hundred and forty-five patients were included with a median age at diagnosis of 61 years. Fifty-one patients (35.2%) had metastatic disease at diagnosis, and 108 (74.5%) had bone metastases at the time of metastatic disease. The median follow-up from the date of metastatic disease was 8.4 years. Eighty-nine (61.4%) patients continued to have disease response to initial therapy after a median of 8.8 years. Thirty-two patients stopped therapy, and of those, 25 recovered testosterone, with 11 patients continuing to have an undetectable prostate-specific antigen (8% of total cohort and 34% of those who stopped therapy). CONCLUSIONS AND CLINICAL IMPLICATIONS: In this cohort, most patients did not have further progression of disease, and 8% of patients had durable treatment-free remissions. Further research is needed on treatment cessation in men with exceptional responses to androgen deprivation therapy.