Clinical features and treatment strategies for older prostate cancer patients with bone metastasis

Abstract

To identify the clinical features and independent predictors of survival in older patients with bone metastasis from prostate cancer (PCa). We retrospectively analysed 205 older patients with bone metastases from PCa between 1997 and 2012. The Kaplan-Meier method was used with the log-rank test for survival rate calculations and to evaluate each variable. Multivariate analysis was performed with the Cox regression model. The chi-squared test was used to compare survival rates between older and younger (n5197) patients. All patients were followed up. The 1-, 2-, 3-and 5-year survival rates were 95.5%, 77.5%, 68.5% and 33.7%, respectively. Gleason score, radiotherapy of the primary tumour, the number of bone metastases, the alkaline phosphatase alkaline phosphatase (ALP) level, organ metastasis and regional lymph node metastasis were associated with the survival rates. Multivariate Cox regression analysis showed that Gleason score at diagnosis of the primary tumour was a significant predictor of overall survival following the diagnosis of bone metastases. In addition, the overall survival rates of older patients were higher compared with younger patients, but older patients who underwent radiotherapy had higher mortality. These data may serve as a guide for creating clinical prediction models in further studies. INTRODUCTIONProstate cancer (PCa) is the most commonly diagnosed malignancy among males in developed countries and the second leading cause of cancer-related mortality. 1 Currently, the incidence is rapidly increasing in developing Asian counties such as China. It is the only solid tumour diagnosed with its first recurrence as bone metastases instead of visceral metastases. PCa frequently metastasizes to bone, and treatment with androgen deprivation leads to accelerated bone loss, resulting in clinically relevant skeletal complications associated with disabling symptoms. 2 Among patients who die from PCa, the incidence of skeletal involvement appears to be .85%. 3,4 Eisenberger and Hussain et al. 5 identified baseline covariates that predict the long-term survival of patients with metastatic PCa based on the Southwest Oncology Group criteria. Minimal disease, better Southwest Oncology Group performance status, no bone pain, lower Gleason score and lower prostate-specific antigen (PSA) level were independent factors associated with longer survival. 5 In our previous study, we found that bone metastasis of PCa was more common in older males, 6 but no prognostic factors for these PCa patients were identified. In this retrospective study, the sample size was enlarged and 205 PCa patients older than 70 with bone metastases were included. The patients' clinical features and main prognostic factors, including age, Gleason score, stage, endocrine therapy, castration, radiotherapy, number of bone lesions, PSA and alkaline phosphatase (ALP) levels, neighbouring organ metastasis, regional and remote lymph node metastases, invasion of the surrounding parenchyma and other

Survival Patterns of Hormone Refractory Prostate Cancer in Sulaymaniyah, Iraqi Kurdistan

“…However, it was observed that older patients with prostate cancer had higher survival durations. This finding is supported by the results of the study carried out by Yang et al (2013) who reported that older patients with single-bone metastasis had a higher survival rate 18 . It was also seen that there was a significant difference between prostate cancer patients with tumors of different stages in terms of their overall survival time (p>0.001), such that patients with tumors stages I had the longest survival duration, followed by those with stages II and II.…”

Risk factors for progression to castration-resistant prostate cancer in metastatic prostate cancer patients

“…The Gleason scoring system is a well-established predictor for staging, progression and prognosis in PCa 14. Yang et al 15 reported that Gleason score was associated with survival of PCa patients with bone metastasis. The overall survival of patients with Gleason score ≤7 was significantly longer than in patients with score >7.…”

Establishing a prediction model for prostate cancer bone metastasis

“…PCa frequently metastasizes to bone, and studies have shown that bone metastases (BMs) have occurred in 13.3%-26% of PCa patients at the first diagnosis in China, which is far more than the rates of 3%-10% in European countries and 3%-5% in the United States 6-8. Once BM occurs in a PCa patient, treatment is very limited and the survival rate is greatly reduced 9. Currently, the technetium Tc 99m methylene diphosphonate (Tc 99m MDP) bone scan method is accepted as the standard and is the most frequently used examination to diagnosis bone metastasis in PCa 10.…”