Risk of skeletal related events among elderly prostate cancer patients by site of metastasis at diagnosis

Abstract

The purpose of this study was to estimate the risk of developing skeletal‐related events (SREs) based on site of metastasis at diagnosis and identify other predictors of developing SREs among metastatic prostate cancer patients. We conducted a retrospective cohort study using linked SEER (Surveillance, Epidemiology, and End Results) and Medicare data and identified men over the age of 65 with incident metastatic prostate cancer diagnosed during 2005–2009. SREs included radiation (RAD), pathological fractures (PF), bone surgery (BS), and spinal cord compression (SCC). The association between site of metastasis at diagnosis and SRE was examined using a Cox proportional hazards model that accounts for death as a competing risk. Among 4404 men (median age: 79 years) with incident metastatic prostate cancer, 44% experienced SREs at a median of 9.6 months post diagnosis. Compared to bone metastasis only, our model showed that patients were significantly less likely to develop SREs if they had LN‐only metastasis at diagnosis (Sub‐Hazard Ratio [SHR] 0.56; 95% Confidence Interval [CI]: 0.43–0.72) or unknown site of metastasis (SHR: 0.79; CI: 0.64–0.97). Other predictors of reduced SRE risk were age 80+ years (SHR: 0.83; CI: 0.75–0.91), non‐Hispanic Black (SHR: 0.77; CI: 0.65–0.90), or being diagnosed in year 2009 (SHR: 0.85; CI: 0.72–0.99). Patients were significantly more likely to develop SREs if they received androgen deprivation therapy (SHR: 1.73; CI: 1.48–2.02) or had Gleason score 8–10 disease (SHR: 0.79; CI: 0.64–0.97). Compared to patients who present with bone metastasis only at diagnosis, patients presenting with other metastatic sites have similar risk of developing SREs, with the exception of those presenting with lymph node only metastasis who have a significantly reduced risk of SREs.

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

“…A study using linked data from the Surveillance, Epidemiology, and End Results program and Medicare examined the risk of SRE development depending on metastatic site . In a cohort of men with metastatic disease, they found that patients with metastases in the bone and lymph nodes, bone and “other” sites (including visceral metastases) with or without lymph nodes, and “other” sites only (including visceral metastases) were as likely as patients with bone metastases only to develop SREs . It is important to note that in the current study, only 44 men (5%) within the mCRPC cohort had visceral metastases at the time of their bone metastasis diagnosis, and despite these small numbers, we did note a significant association.…”

“…Second, patients with visceral metastases within 1 month before or after bone metastasis diagnosis were more likely to develop an SRE compared with those without visceral metastases (HR, 1.91; 95% CI, 1.18‐3.09). A study using linked data from the Surveillance, Epidemiology, and End Results program and Medicare examined the risk of SRE development depending on metastatic site . In a cohort of men with metastatic disease, they found that patients with metastases in the bone and lymph nodes, bone and “other” sites (including visceral metastases) with or without lymph nodes, and “other” sites only (including visceral metastases) were as likely as patients with bone metastases only to develop SREs .…”

“…Most notably, we identified bone pain at the time of bone mCRPC diagnosis as the strongest predictor of SREs . Other studies have identified biopsy grade group and number of bone lesions at the time of diagnosis as significant risk factors for the development of SREs . Given the impact of SREs on morbidity and mortality, the objective of the current study was to perform what to our knowledge is one of the largest retrospective cohort studies in men with mCRPC with longer follow‐up to identify predictors of SREs and the impact of these predictors on all‐cause mortality.…”

Importance of non‐regional lymph nodes in assigning risk in primary metastatic prostate cancer

“…They also reported an increased risk of death in patients with bone + NRLN metastases compared to patients with only bone metastases (HR 1.37, 95% CI 1.17–1.6) for the overall cohort after adjusting for treatment received, baseline pain, Karnofsky performance score, prior progression type, PSA, tumour grade, alkaline phosphatase level and haemoglobin level. Furthermore, a recent SEER Medicare analysis of 4 404 patients with mPCa was conducted to evaluate the relationship of metastatic sites to skeletal‐related events . This study reported that patients with bone + NRLN metastases have a higher probability of developing skeletal‐related events compared with patients with only bone metastases (52% vs 46%).…”

Screening the active compounds of Phellodendri Amurensis cortex for treating prostate cancer by high-throughput chinmedomics

“…With the rapid increase of its incidence and mortality rate, more and more patients are suffering from the associated emotional and physical burden, and the mortality rate of prostate cancer is second only to lung cancer34: because of the high progression, invasion, and metastasis rates of prostate cancer, it causes the highest mortality rate and has the lowest survival rate567. Prostate cancer threatens male health at all times8.…”