Presenter(s)
J. S. Cummock1,2, A. J. Haider2,3, V. Davidov2,3, K. T. Tran2, W. Haque2, E. B. Butler2, B. S. Teh2, and A. M. Farach2; 1Texas A&M University Naresh K. Vashisht College of Medicine, Bryan, TX, 2Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, 3Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX
Purpose/Objective(s): Cribriform prostate carcinoma is associated with aggressive biology, yet population-level data describing real-world treatment patterns and outcomes are limited. We evaluated the association between first-course treatment strategy and overall survival (OS) in men with cribriform prostate carcinoma in a population-based database.
Materials/Methods: We queried the U.S. Surveillance, Epidemiology, and End Results (SEER) database for men diagnosed with malignant cribriform prostate carcinoma (ICD-O-3 8201/3) from 2004–2022. For comparative analyses, we restricted to first primary diagnoses with interpretable first-course surgery and radiation variables. First-course treatment was categorized as surgery only, radiation only, surgery + radiation, or neither/unknown. Stage was categorized as localized, regional, distant, or unknown. The primary outcome was OS; cause-specific survival (CSS) was secondary. Kaplan–Meier methods with log-rank tests were used for unadjusted comparisons. Multivariable Cox proportional hazards models were stratified by stage and adjusted for age and year of diagnosis.
Results: SEER identified 237 men with malignant cribriform prostate carcinoma; 93 met criteria for comparative analysis (50 deaths). First-course management was surgery only in 35 (37.6%), radiation only in 26 (28.0%), surgery + radiation in 8 (8.6%), and neither/unknown in 24 (25.8%). Treatment patterns varied across eras (2004–2009, 2010–2015, 2016–2022): surgery-only use was 28.9%, 50.0%, and 41.7%, while radiation-only use was 37.8%, 4.2%, and 33.3%. Median follow-up among survivors was 90 months. Five-year OS was 76.3% (surgery only), 72.1% (radiation only), 85.7% (surgery + radiation), and 60.4% (neither/unknown) (log-rank p=0.17). In adjusted stage-stratified Cox models (reference=surgery only), hazard ratios were 1.02 for radiation only (95% CI 0.45–2.30), 2.45 for surgery + radiation (0.77–7.83), and 1.16 for neither/unknown (0.50–2.65). Increasing age was associated with higher mortality (HR 1.07 per year, 95% CI 1.03–1.11). CSS analyses were limited by few events (n=21); five-year CSS was 87.7%, 84.2%, 100%, and 74.4%, respectively (log-rank p=0.81).
Conclusion: In this population-based SEER cohort, first-course management of cribriform prostate carcinoma was varied, with substantial use of radiation-only strategies and infrequent combined-modality treatment despite the recognized aggressive phenotype. While stage-stratified multivariable models did not demonstrate statistically significant OS/CSS differences between surgery-only and radiation-only approaches, stage-specific Kaplan–Meier patterns in localized/regional disease suggested potentially clinically meaningful separation, supporting the need for focused comparative effectiveness studies that evaluate histology-specific treatment optimization to clarify when definitive radiation alone is sufficient versus when multimodality therapy may be warranted.