Bone Metastasis at Diagnosis Predicts Early Prostate Cancer Mortality
Men who present with prostate cancer bone metastasis and no visceral metastases have a median survival time of 37 months, study finds.
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BOSTON—Men who have prostate cancer (PCa) bone metastases at diagnosis are at risk of dying within 3 years, according to study findings presented at the American Urological Association 2017 annual meeting.
Using the Surveillance, Epidemiology, and End Results (SEER) database, Zachary Klaassen, MD, and colleagues at the University of Toronto looked at predictors of PCa-specific mortality (PCSM) in a cohort of 8040 men who presented with PCa bone metastases. The median follow-up was 35 months. A total of 2497 men (31.1%) died from PCa and 5542 (68.9%) did not; 643 (8%) died from other causes.
The additional presence of brain, liver, and lung metastasis at diagnosis was associated with a 1.5, 2.1, and 1.3 times increased risk of PCSM compared with the absence of these metastases.
The median survival time was 37 months for men with bone metastases only. The median survival times were 27 months, 15 months, and 11 months for men with bone plus lung metastases, bone plus liver metastases, and bone plus lung and liver metastases, respectively.
Other PCSM predictors were older age, higher PSA levels, being unmarried (vs married), living in the South (vs the Northeast), biopsy Gleason group 4 and 5, and the absence of a prostate biopsy.
“Although there are limitations associated with the SEER database, specifically related to concomitant treatment, it allows a population-based assessment of demographics and clinicopathologic variables associated with a high-risk cohort of men that will present with metastasis at diagnosis and succumb early of their disease,” Dr. Klaassen, a urologic oncology fellow at the University Health Network-Princess Margaret Cancer Centre in Toronto, told Renal & Urology News. “Furthermore, there are important geographical disparities in outcomes pertaining to patients in the southern US that require further evaluation. Certainly patients with high-volume visceral metastasis at diagnosis require aggressive systemic therapy akin to [that used in] the CHAARTED and STAMPEDE trials, given their risk of early mortality found in this study.”
The trials provided data supporting the combined use of docetaxel and androgen-deprivation therapy for patients with hormone-sensitive metastatic PCa.
Klaassen Z, Chandrasekar T, Goldberg H, et al. Predictors of early disease specific mortality among patients with prostate adenocarcinoma bone metastasis at diagnosis. [abstract]. J Urol 2017;197(4S):e170. Poster presented at the American Urological Association 2017 annual meeting in Boston on May 12, 2017. Poster MP14-20.