OBJECTIVE: To report a simplified and effective method for substratification of M1 castrate resistant prostate cancer by correlating progression free and overall survival with simple numeric quantification of skeletal metastases.
PATIENTS AND METHODS: 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 cut off points of 1-4, 5-20 and >20 detectable lesions.
RESULTS: Patients with a higher metastasis number had a shorter progression free (PFS) and overall (OS) survival (HR=2.0 (95% CI: 1.7-2.4) p< 0.001. Men with 1-4 metastases had much better PFS and OS compared to those with 5-20 metastases. Median PFS and OS in the latter was 10.9 (95% CI: 8.4-12.8) and 22.1 months (95% CI: 18.5-24.5) respectively. PFS and OS for patients with >20 metastases were shorter still (median 5.3 (95% CI: 3.4-6.9) and 13.3 (95% CI: 11.3-17.6months 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) p< 0.001) and OS (18.7 months (95% CI: 17.5-22.1) p< 0.001).
CONCLUSION: Dichotomising CRPC patients into cohorts with 1-4 or ≥5 skeletal metastases identifies a better and a worse cohort in a manner which 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.
Written by:
Tait C, Moore D, Hodgson C, Brown M, Morris T, Growcott J, Malone M, Hughes A, Renehan A, Clarke N, Dive C. Are you the author?
The Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, University of Manchester, M20 4BX, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK; Department of Urology, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK.
Reference: BJU Int. 2014 Mar 3. Epub ahead of print.
doi: 10.1111/bju.12717
PubMed Abstract
PMID: 24589330
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