Quantification of skeletal metastases in castrate‐resistant prostate cancer predicts progression‐free and overall survival

Abstract

ObjectiveTo report a simplified and effective method for substratification of M1 castrate-resistant prostate cancer (CRPC) by correlating progression-free (PFS) and overall survival (OS) with simple quantification of skeletal metastases. Patients and MethodsIn all, 561 men with M1 CRPC were studied longitudinally. Individual bone scan disease burden, quantified by counting bone metastasis number, was correlated with clinical outcome using specific threshold points of 1-4, 5-20 and >20 detectable lesions. ResultsPatients with a higher metastasis number had a shorter PFS and OS (hazard ratio [HR] 2.0, 95% confidence interval [CI] 1.7-2.4; P < 0.001). Patients with 1-4 metastases had much better PFS and OS than those with 5-20 metastases. The median PFS and OS in the latter was 10.9 (95% CI 8.4-12.8) and 22.1 (95% CI: 18.5-24.5) months, respectively. PFS and OS for patients with >20 metastases were shorter still [median 5.3 (95% CI 3.4-6.9) months and 13.3 (95% CI 11.3-17.6) months, respectively]. Dichotomising into cohorts with 1-4 and ≥5 metastases, the latter group had considerably poorer PFS [8.4 (95% CI 6.8-10.3) months; P < 0.001) and OS [18.7 (95% CI 17.5-22.1) months; P < 0.001]. ConclusionsDichotomising patients with CRPC into cohorts with 1-4 or ≥5 skeletal metastases identifies a better and a worse cohort in a manner that is easy and clinically accessible. This simple method facilitates disease stratification and patient management, enabling clinicians to counsel patients more effectively about long-term outcomes and to help select intervention therapies more effectively.

Predictors of skeletal‐related events and mortality in men with metastatic, castration‐resistant prostate cancer: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database

“…Tait et al studied skeletal metastases in patients with CRPC. Patients with 5 to 20 metastases were found to have a median overall survival of 22.1 months whereas patients with ≥20 metastases had a median overall survival of 13.3 months . It is interesting to note that we found that all‐cause mortality was influenced by the type of primary therapy.…”

“…Patients with 5 to 20 metastases were found to have a median overall survival of 22.1 months whereas patients with ≥20 metastases had a median overall survival of 13.3 months. 33 It is interesting to note that we found that all-cause mortality was influenced by the type of primary therapy. A regimen of radiotherapy and radical prostatectomy was found to have a protective effect on patients' all-cause mortality compared with no localized Cancer November 15, 2019 therapy at all.…”

Prognostic Factors for Survival in Noncastrate Metastatic Prostate Cancer: Validation of the Glass Model and Development of a Novel Simplified Prognostic Model

“…In particular, information on bone metastases was restricted to presence or absence. As discussed above, localization of bone disease is an independent prognostic factor according to Glass et al, and the number of bone metastases, regardless of localization, is an important prognostic variable [19]. In the ECOG study, a high burden of metastatic disease was a [ ( F i g .…”

Prognostic Utility of PET in Prostate Cancer

“…Bone scan index captures the burden of osseous metastatic disease that has been shown to relate to outcome. Tait et al quantified the bone scan by simply counting the bone metastases in 561 men with metastatic castrate-resistant prostate cancer and correlating clinical outcome to thresholds of 1–4, 5–20 and >20 detectable bone lesions (67). Patients with higher number of bone metastases had shorter progression-free survival and overall survival.…”