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Prognostic Impacts of Metastatic Site and Pain on Progression to Castrate Resistance and Mortality in Patients with Metastatic Prostate Cancer.

Koo KC, Park SU, Kim KH, Rha KH, Hong SJ, Yang SC, Chung BH - Yonsei Med. J. (2015)

Bottom Line: A retrospective analysis was performed on 440 consecutive treatment-naïve patients initially diagnosed with mPCa between August 2000 and June 2012.Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed.Metastatic spread and pain patterns confer different prognosis in patients with mPCa.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To investigate predictors of progression to castration-resistant prostate cancer (CRPC) and cancer-specific mortality (CSM) in patients with metastatic prostate cancer (mPCa).

Materials and methods: A retrospective analysis was performed on 440 consecutive treatment-naïve patients initially diagnosed with mPCa between August 2000 and June 2012. Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed. Cox-proportional hazards regression analyses were used to evaluate survivals and predictive variables of men with bone metastasis stratified according to the presence of pain, compared to men with visceral metastasis.

Results: Metastases were most often found in bone (75.4%), followed by lung (16.3%) and liver (8.3%) tissues. Bone metastasis, pain, and high BMI were associated with increased risks of progression to CRPC, and bone metastasis, pain, PSA nadir, and ECOG PS≥1 were significant predictors of CSM. During the median follow-up of 32.0 (interquartile range 14.7-55.9) months, patients with bone metastasis with pain and patients with both bone and visceral metastases showed the worst median progression to CRPC-free and cancer-specific survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals.

Conclusion: Metastatic spread and pain patterns confer different prognosis in patients with mPCa. Bone may serve as a crucial microenvironment in the development of CRPC and disease progression.

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Related in: MedlinePlus

Comparative survival curves of patients with metastatic prostate cancer for (A) progression to castration-resistant prostate cancer (CRPC)-free survival and (B) cancer-specific survival.
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Related In: Results  -  Collection

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Figure 1: Comparative survival curves of patients with metastatic prostate cancer for (A) progression to castration-resistant prostate cancer (CRPC)-free survival and (B) cancer-specific survival.

Mentions: Survival results as of March 2014 were used in this analysis. With pain revealed as a predictor for survival in the multivariable analysis, patients with bone metastasis were stratified according to the presence of pain and compared to patients with visceral metastasis and those with both bone and visceral metastases. The median intervals from initial diagnosis of metastasis to CRPC progression and CSM, as well as the survival outcome of each group, are presented in Table 4 and Fig. 1. Due to clinicopathological heterogeneity across subgroups, which may have confounded our ability to determine the influence of bone metastasis and the presence of pain on survival outcomes, we evaluated the comparative survival of patients after adjustment for covariates considered potential predictors by the Cox-proportional hazards analysis. For all study endpoints, patients with bone metastasis accompanied by pain and patients with both bone and visceral metastases had the worst median survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals.


Prognostic Impacts of Metastatic Site and Pain on Progression to Castrate Resistance and Mortality in Patients with Metastatic Prostate Cancer.

Koo KC, Park SU, Kim KH, Rha KH, Hong SJ, Yang SC, Chung BH - Yonsei Med. J. (2015)

Comparative survival curves of patients with metastatic prostate cancer for (A) progression to castration-resistant prostate cancer (CRPC)-free survival and (B) cancer-specific survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541648&req=5

Figure 1: Comparative survival curves of patients with metastatic prostate cancer for (A) progression to castration-resistant prostate cancer (CRPC)-free survival and (B) cancer-specific survival.
Mentions: Survival results as of March 2014 were used in this analysis. With pain revealed as a predictor for survival in the multivariable analysis, patients with bone metastasis were stratified according to the presence of pain and compared to patients with visceral metastasis and those with both bone and visceral metastases. The median intervals from initial diagnosis of metastasis to CRPC progression and CSM, as well as the survival outcome of each group, are presented in Table 4 and Fig. 1. Due to clinicopathological heterogeneity across subgroups, which may have confounded our ability to determine the influence of bone metastasis and the presence of pain on survival outcomes, we evaluated the comparative survival of patients after adjustment for covariates considered potential predictors by the Cox-proportional hazards analysis. For all study endpoints, patients with bone metastasis accompanied by pain and patients with both bone and visceral metastases had the worst median survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals.

Bottom Line: A retrospective analysis was performed on 440 consecutive treatment-naïve patients initially diagnosed with mPCa between August 2000 and June 2012.Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed.Metastatic spread and pain patterns confer different prognosis in patients with mPCa.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To investigate predictors of progression to castration-resistant prostate cancer (CRPC) and cancer-specific mortality (CSM) in patients with metastatic prostate cancer (mPCa).

Materials and methods: A retrospective analysis was performed on 440 consecutive treatment-naïve patients initially diagnosed with mPCa between August 2000 and June 2012. Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed. Cox-proportional hazards regression analyses were used to evaluate survivals and predictive variables of men with bone metastasis stratified according to the presence of pain, compared to men with visceral metastasis.

Results: Metastases were most often found in bone (75.4%), followed by lung (16.3%) and liver (8.3%) tissues. Bone metastasis, pain, and high BMI were associated with increased risks of progression to CRPC, and bone metastasis, pain, PSA nadir, and ECOG PS≥1 were significant predictors of CSM. During the median follow-up of 32.0 (interquartile range 14.7-55.9) months, patients with bone metastasis with pain and patients with both bone and visceral metastases showed the worst median progression to CRPC-free and cancer-specific survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals.

Conclusion: Metastatic spread and pain patterns confer different prognosis in patients with mPCa. Bone may serve as a crucial microenvironment in the development of CRPC and disease progression.

Show MeSH
Related in: MedlinePlus