Original article: Prognostic factors in hormone-resistant progressing cancer of the prostate

Abstract

In 224 consecutive patients with hormone-resistant prostatic cancer referred to 2 European Cancer Centres for palliation of painful bone metastases the one year survival for all patients was 24% (2-year survival: 7%). The median survival was 8 months. In univariate analyses the following prognostic factors were identified: performance status, serum creatinine, alkaline phosphatase, duration of response to primary hormone treatment, degree of bone scan involvement and hemoglobin. Multivariate analyses confirmed the four first parameters to be independent factors. A prognostic model was established (no or one risk factors vs 2 risk factors vs 3 or 4 risk factors) based on performance status, creatinine, alkaline phosphatase and hormone response duration. The median survival of these groups was 10 months, 6 months and 3 months, respectively. This model proved to be discriminative in an external data set of 214 patients with hormone-resistant prostatic cancer entered in two prospective trials. The above differences in outcome between readily and simply defined prognostic groups are greater than the differences one can realistically hope to produce using new treatment strategies. These prognostic factors should be taken into account both in the design and interpretation of clinical studies dealing with the treatment of hormone-resistant progressing prostatic cancer and painful bone metastases.

Weekly epirubicin in patients with hormone-resistant prostate cancer

“…This high response rate may be related to the real anti-tumour activity of epirubicin, and/or the baseline characteristics of the patients. It is known that some prognostic factors, such as a long period of responsiveness to previous hormonal therapy, a good performance status and a limited extension of bone metastases are usually correlated with a more favourable disease outcome (Fossa et al, 1992;Hussain et al, 1994). About 85% of our patient population had responded to previous hormonal treatment for 412 months, but most of them had widespread bone metastases and a poor performance status.…”

Androgen-independent Prostate Cancer The Clinical Problem of a Growing Pelvic Tumour

“…Lankford et al (7) reported a 60% 2-years survival after palliative pelvic RT of pelvisconfined AIPC. Our group has recently shown a median survival time from the first TUR-P after diagnosis of symptomatic AIPC of 14 months (8) as compared to 8 Á/ 10 months in AIPC patients with irradiated painful bone metastases (1).…”

“…Although many of these patients are initially palliated by androgen deprivation, not all achieve a durable control of the primary tumour. Fosså et al previously indicated that about 18% of all AIPC patients referred to palliative RT presented urinary symptoms and pelvic soft tissue pain as the dominating symptoms at diagnosis of AIPC (1). The clinical scenario in these patients and their clinical course after development of AIPC has only limitedly been dealt with in the medical literature (3,7,13,14).…”

High activity Rhenium-186 HEDP with autologous peripheral blood stem cell rescue: a phase I study in progressive hormone refractory prostate cancer metastatic to bone

“…Once this strategy has failed, second line treatments including corticosteroids, anti-androgens, diethylstilbesterol and cytotoxic chemotherapy including estramustine have only had limited success in preventing disease progression with short-lasting subjective responses in approximately 30% of cases (Dearnaley, 1994;Tannock et al, 1996;Pisters, 1999). The average survival in patients with hormone refractory prostate cancer metastatic to bone is in the order of 8 months (Fossa et al, 1992;Kelly et al, 1993;Sridhara et al, 1995;Small and Vogelzang, 1997). Radionuclides including strontium-89, rhenium-186 and samarium-153 have been used in the palliation of bone metastases in prostate cancer (Lewington et al, 1991;Porter et al, 1993;Quilty et al, 1994;Kolesnikov-Gauthier et al, 2000).…”