Characteristics and outcomes of men presenting with complications of metastatic prostate cancer

To describe the incidence, characteristics and mortality of men who present with complications of metastatic prostate cancer, a previously under-reported population. We investigate men who present with and without malignant ureteric obstruction (MUO) and skeletal-related events (SREs), collectively termed 'metastatic-related events' (MREs).

We used the English Cancer Registry linked to hospital administrative data to identify men diagnosed with metastatic prostate cancer between January 2015 and December 2022. Poisson regression models estimated adjusted relative risks (aRRs) of presenting with MREs. The cumulative incidences of overall and prostate cancer-specific death were estimated for each MRE subgroup (metastatic without MRE, MUO, SRE, and MUO and SRE in combination).

Of 48 171 men diagnosed with primary metastatic disease, 4272 (8.9%) presented with MREs. Of these men, 2453 (57.4%) had MUO, 1738 (40.7%) had a SRE, and 81 (1.9%) had both. Men aged ≥80 years had the highest risk (9.8% [1604/16452]) of presenting with MREs. Men aged 70-79 years (8.0% [1470/18397]) (aRR 0.82, 95% confidence interval [CI] 0.77-0.88) and men aged 60-69 years (8.9% [916/10297]) (aRR 0.91, 95%CI 0.84-0.98) had lower risks. Men from the most deprived neighbourhoods (9.3% [706/7609]) (aRR 1.27, 95% CI 1.15-1.40) had greater risks of presenting with MREs than those from the least deprived neighbourhoods (8.0% [868/10865]). The proportion of men presenting with MREs varied across geographical regions, ranging from 4.6% (288/6233) to 11.7% (461/3951). The 5-year overall mortality for men presenting without MREs was 57.8% (95% CI 57.2-58.4%), compared to 77.1% (95% CI 74.9-79.2%) with MUO, 66.8% (95% CI 64.1-69.4%) with a SRE and 84.4% (95% CI 74.1-94.7%) with both.

The risk of presenting with metastatic prostate cancer and MREs varies according to age, socioeconomic deprivation, and residential region. These men have poorer survival outcomes than men diagnosed without MREs at diagnosis.