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Presentation of Patients with Metastatic Prostate Cancer in the Post-PSA Era
Rian J. Dickstein, M.D., Jamal A. Nabhani, B.S., Jessica E. Kreshover, M.D., Richard K. Babayan, M.D., Mark H. Katz, M.D., Gretchen A. Gignac, M.D..
Boston University School of Medicine, Boston, MA, USA.

BACKGROUND: Metastatic prostate cancer (MPC) continues to have a high incidence but is variable in presentation. We identified two groups of patients with MPC; those with metastatic disease at the time of initial diagnosis and those who progressed from localized disease. We sought to identify differences in clinical, pathologic, socioeconomic factors, and survival metrics between the two cohorts.
METHODS: We identified patients with MPC from 2003 to 2008 at a single institution. Patient related factors [age, Gleason score, prostate specific antigen (PSA), digital rectal exam (DRE), radiographic findings, family history, age-adjusted Charlson comorbidity index (CCI), body mass index (BMI), and smoking history], demographic and socioeconomic factors (ethnicity/race and insurance status) and survival outcomes (1-year and time from diagnosis of metastases to death) were compared between the two cohorts using a two sided student’s t-test and test of proportions.
RESULTS: Seventy patients developed MPC an average of 6.7 years (0.5 - 20.5) after being initially diagnosed with localized disease and 100 patients had metastases at initial presentation. Statistically, there were differences in patient related factors between the patients who progressed to as opposed to presented with metastases including the following: older age (71.7 vs 67.1 years), lower grade disease (3.66 vs 4.06 primary Gleason score and 7.56 vs 8.22 Gleason sum), decreased proportion with an abnormal DRE (72.9 vs 86.1%), and a higher CCI (4.79 vs 4.22) (Table 1A). There was no difference in demographic or socioeconomic factors between the two cohorts (Table 1B). Thirty five patients who presented with metastases and 24 patients who progressed from localized disease died during the study period; however, there was no difference in survival outcomes between the two groups (Table 1C).
CONCLUSIONS: There are very few differences between patients who present with MPC at the time of diagnosis and those who progress from localized disease. Patients who present with MPC at initial diagnosis appear to be younger, have higher grade disease, and less comorbid disease than those progressing to metastatic cancer. However, once metastases have developed, our analysis suggests that there is no survival difference, regardless of the factors leading to the diagnosis.


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