Abstract | BACKGROUND: Isolated pulmonary involvement is uncommon in metastatic hormone-sensitive prostate cancer (mHSPC). To characterize outcomes and molecular alterations of this unique patient subset, we conducted a retrospective review of patients with hormone-naïve prostate cancer presenting with lung-only metastases. METHODS: This was a retrospective single-institution study. Medical records of 25 patients presenting with pulmonary-only metastases before receiving androgen deprivation therapy (ADT) were analyzed. Germline and/or somatic genomic results, where available (n = 16), were documented. Tumor tissue was analyzed using clinical-grade next-generation DNA sequencing assays. Clinical endpoints included complete prostate-specific antigen (PSA) response to ADT (<0.1 ng/mL), median overall survival (OS) from time of ADT initiation, median PSA progression-free survival (PSA-PFS), and failure-free survival (FFS) at 4 years. RESULTS: Baseline characteristics were notable for 48% of men (12 of 25) having first or second-degree relatives with prostate cancer, compared with 20% expected. Complete PSA responses to ADT were noted in 52% of men, with a median PSA-PFS of 66 months, a 4-year FFS rate of 72%, and a median OS that was not reached after 190 months. In evaluable patients, molecular drivers were enriched for mismatch repair mutations (4 of 16, 25%) and homologous-recombination deficiency mutations (4 of 16, 25%). These results are limited by the small sample size and retrospective nature of this analysis. CONCLUSIONS: This exploratory study represents one of the largest cohorts of lung-only mHSPC patients to-date. The prevalence of actionable DNA-repair gene alterations was higher than anticipated (any DNA-repair mutation: 8 of 16, 50%). Compared to historical data, these patients appear to have exceptional and durable responses to first-line ADT. This study suggests that pulmonary-tropic mHSPC biology may be fundamentally different from nonpulmonary mHSPC.
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Authors | Eugene Shenderov, Pedro Isaacsson Velho, Anas H Awan, Hao Wang, Nooshin Mirkheshti, Tamara L Lotan, Michael A Carducci, Drew M Pardoll, Mario A Eisenberger, Emmanuel S Antonarakis |
Journal | The Prostate
(Prostate)
Vol. 79
Issue 13
Pg. 1572-1579
(09 2019)
ISSN: 1097-0045 [Electronic] United States |
PMID | 31389628
(Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
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Copyright | © 2019 Wiley Periodicals, Inc. |
Topics |
- Aged
- Cohort Studies
- Humans
- Lung Neoplasms
(genetics, secondary)
- Male
- Middle Aged
- Mutation
- Prostatic Neoplasms
(genetics, pathology)
- Prostatic Neoplasms, Castration-Resistant
(genetics, pathology)
- Retrospective Studies
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