Differential prognostic factors in low- and high-burden de novo metastatic hormone-sensitive prostate cancer patients

Cancer Sci. 2021 Apr;112(4):1524-1533. doi: 10.1111/cas.14722. Epub 2021 Feb 13.


Metastatic burden is a critical factor for therapy decision-making in metastatic hormone-sensitive prostate cancer. The present study aimed to identify prognostic factors in men with high- or low-metastatic burden treated with primary androgen-deprivation therapy. The study included 2450 men with de novo metastatic prostate cancer who were treated with primary androgen-deprivation therapy at 30 institutions across Japan between 2008 and 2017. We investigated the prognostic value of various clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) in patients stratified by low- or high-metastatic burden. Among the 2450 men, 841 (34.3%) and 1609 (65.7%) were classified as having low- and high-metastatic burden, respectively. Median PFS of the low- and high-burden groups were 44.5 and 16.1 months, respectively, and the median OS was 103.2 and 62.7 months, respectively. Percentage of biopsy-positive core, biopsy Gleason grade group, T-stage, and N-stage were identified to be differentially prognostic. M1a was associated with worse PFS than was M1b in the low-burden group, whereas lung metastasis was associated with better PFS and OS than was M1b in the high-burden group. Differential prognostic factors were identified for patients with low- and high-burden metastatic prostate cancer. These results may assist in decision-making to select the optimal therapeutic strategies for patients with different metastatic burdens.

Keywords: androgen-deprivation therapy; hormone-sensitive prostate cancer; metastatic burden; metastatic prostate cancer; prognostic factor.

MeSH terms

  • Aged
  • Androgen Antagonists / therapeutic use
  • Biopsy / methods
  • Hormones / metabolism*
  • Humans
  • Japan
  • Male
  • Neoplasm Staging / methods
  • Prognosis
  • Progression-Free Survival
  • Prostatic Neoplasms / drug therapy
  • Prostatic Neoplasms / metabolism*
  • Prostatic Neoplasms / pathology*
  • Retrospective Studies


  • Androgen Antagonists
  • Hormones