Risk Factors and Treatment Outcomes in Metastatic Prostate Cancer With Brain Metastases

Area of Science:

• Oncology
• Neuro-oncology
• Prostate Cancer Research

Background:

• Prostate cancer with brain metastases (PCBM) is a rare complication with a poor prognosis.
• Risk factors and optimal treatment strategies for PCBM remain poorly understood.

Purpose of the Study:

• To investigate the incidence, risk factors, and survival outcomes for patients with PCBM.
• To evaluate the impact of various systemic and local treatments on overall survival in PCBM patients.

Main Methods:

• Utilized the National Cancer Database (NCDB) from 2010-2021 for patients with metastatic prostate cancer (mPCa).
• Conducted temporal analysis, multivariable logistic regression for risk factors, and Kaplan-Meier/Cox models for overall survival (OS).
• Performed subgroup analyses on systemic therapies (immunotherapy, hormone therapy, chemotherapy) and local treatments (surgery, WBRT, SRS).

Main Results:

• PCBM occurred in 1.1% (1144/101,900) of mPCa patients, with no significant temporal increase in incidence.
• Neuroendocrine histology, liver metastases, and other peripheral organ metastases were independent risk factors for PCBM.
• PCBM patients had significantly worse OS (15.1 vs 32.6 months). Immunotherapy and hormone therapy improved OS compared to hormone therapy alone (42.6 vs 17.2 months).
• Immunotherapy demonstrated a positive OS benefit (aHR=0.20), while whole brain radiation therapy (WBRT) was associated with worse survival (aHR=3.38).

Conclusions:

• PCBM is associated with aggressive disease features, including neuroendocrine histology.
• Systemic disease control is crucial for durable survival, with potential benefits from local therapies in select cases.
• Future research should focus on molecular stratification and include PCBM patients in clinical trials.