Evaluation of Time to Metastasis After Prostatectomy as a Prognostic Factor in Patients With Metachronous mHSPC: A Secondary Analysis of the SWOG-1216 Phase 3 Trial
In brief
Time to metastasis after prostatectomy did not predict survival in 301 patients
In this secondary analysis of a phase 3 trial, the time from prostate removal to metastatic hormone-sensitive prostate cancer was not associated with progression-free or overall survival, whether measured continuously or by different year-based cutoffs. The finding held across treatment groups, but the analysis included only 301 patients, and time to metastasis alone may not be enough to guide counseling or treatment decisions.
- Journal
- The Prostate (Q1)
- Published
- 6 October 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Nicolas Sayegh, Yeonjung Jo, Umang Swami, Varun Nandakumar, Georges Gebrael, Zeynep Irem Ozay, et al.
- PMID
- 42837091
- DOI
- 10.1002/pros.70266
Why clinicians should know about it
- Picked for Urology (paper of the day, 7 October 2026): Excluded – secondary analysis of metastatic hormone‑sensitive prostate cancer
Abstract
BACKGROUND: The prognostic significance of time to metastasis (TTM) following radical prostatectomy in patients with metachronous metastatic hormone-sensitive prostate cancer (mHSPC) remains uncertain. We performed a secondary analysis of patient-level data from the phase 3 SWOG 1216 randomized clinical trial to evaluate whether TTM is associated with progression-free survival (PFS) or overall survival (OS). METHODS: Among 1279 trial participants, 301 patients with metachronous mHSPC who had previously undergone prostatectomy were included. Participants were randomized to androgen deprivation therapy (ADT) plus orteronel or ADT plus bicalutamide and followed through 2023. TTM was analyzed as both a continuous variable and using categorical thresholds ranging from 1 to 10 years. Multivariable Cox proportional hazards models adjusted for treatment arm, disease burden, Gleason score, performance status, prostate-specific antigen, age, and prior ADT. RESULTS: Of the included patients, 161 received ADT plus orteronel and 140 received ADT plus bicalutamide; 38% had extensive disease. TTM was not associated with PFS when analyzed continuously (hazard ratio [HR], 1.0; p = 0.30) or categorically across any threshold. Similarly, TTM was not associated with OS (continuous HR, 1.0; p = 0.14), with consistent findings across treatment arms. CONCLUSIONS: In the secondary analysis of SWOG 1216, TTM was not independently associated with survival outcomes in the multivariable analysis. These findings suggest that TTM alone may not provide sufficient prognostic information to guide patient counseling, and treatment decisions after metastatic recurrence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.