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Risk Factors and Treatment Outcomes in Metastatic Prostate Cancer With Brain Metastases
Vincent E Xu1, Jeffrey Wang1, Rachel C Bernardo1
1George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Introduction:
Prostate cancer with brain metastases (PCBM) is rare and carries a poor prognosis. However, the risk factors and optimal treatment strategies for PCBM are poorly understood.
Patient And Methods:
The National Cancer Database (NCDB) was queried for patients diagnosed with metastatic prostate cancer (mPCa) from 2010 to 2021. Demographics, tumor characteristics, and treatments were compared between patients with and without PCBM. PCBM incidence and risk factors were assessed with temporal analysis and multivariable logistic regression. Overall survival (OS) was analyzed using Kaplan-Meier and Cox proportional hazards models. Subgroup analyses examined combinations of systemic and local treatments including surgery of metastasis sites, whole brain radiation (WBRT), and stereotactic radiosurgery (SRS).
Results:
Of 101,900 patients with mPCa, 1144 (1.1%) had PCBM. No significant temporal increase in PCBM incidence was observed. Neuroendocrine (NE) histology (aOR: 3.92, 95%CI: 1.09-14.13), liver metastases (aOR: 2.86, 95%CI: 1.68-8.84), and other peripheral organ metastases (aOR: 2.47, 95%CI: 1.10-5.54) were independently associated with PCBM risk. Patients with PCBM had worse OS (15.1 vs 32.6 months, P < .001). Immunotherapy and hormone therapy were associated with significantly improved OS compared to hormone therapy alone (42.6 vs 17.2 months, P = .002). In multivariable analysis, immunotherapy had a positive OS benefit (aHR = 0.20, 95%CI: 0.05-0.75) while WBRT was associated with worse survival (aHR = 3.38, 95%CI: 1.69-6.76). Chemotherapy, surgery, and SRS had no significant OS benefit after controlling for confounding.
Conclusion:
PCBM is associated with aggressive disease features such as NE histology. Durable survival appears primarily dependent on systemic disease control, with local therapies potentially offering additional benefit in select cases. These findings underscore the need for molecular stratification and advocate for the inclusion of PCBM patients in future clinical trials.
