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Clinical presentation and predictors of survival related to extent of bone metastasis in 900 prostate cancer patients
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Urology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
EpiStat, Sweden.
Karolinska Institute, Sweden.
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2016 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, no 5, 352-359 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to investigate the impact of bone metastasis on survival and quality of life (QoL) in men with hormone-naive prostate cancer. Materials and methods: The study included 900 patients from a randomized trial (No. 5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade. Extent of bone metastasis was categorized according to a modified Soloway score: score 1, n=319; score 2, n = 483; and score 3, n = 98 patients. The primary outcome measurements were mean differences in QoL and overall survival. Results: QoL rating scales showed a decrease with increasing extent of bone metastasis (p amp;lt; 0.001). The mean global health status decreased from 64.4 to 50.5 for Soloway score 1 and 3, respectively. Following adjustment for performance status, analgesic consumption, grade of malignancy, alkaline phosphatase, prostate-specific antigen, haemoglobin and global health status, Soloway score 2 and 3 had a 47% [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.21-1.80] and 78% (HR 1.78 95%, CI 1.32-2.42) increased mortality, respectively, compared to Soloway score 1. Independent predictive factors of mortality were assessed. Conclusions: Patient grouping based on three categories of extent of bone metastasis related to performance status, haemoglobin and global health status at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2016. Vol. 50, no 5, 352-359 p.
Keyword [en]
Androgen deprivation treatment; bone metastasis; extent of disease; hormone-naive; predictors of survival; prostate cancer
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:liu:diva-132207DOI: 10.1080/21681805.2016.1209689ISI: 000384068000005PubMedID: 27603423OAI: oai:DiVA.org:liu-132207DiVA: diva2:1043951
Note

Funding Agencies|Ferring AB, Malmo, Sweden; Ferring Laegemidler A/S, Copenhagen, Denmark; Pharmacia AB, Uppsala, Sweden; Schering-Plough AB, Stockholm, Sweden

Available from: 2016-11-01 Created: 2016-10-21 Last updated: 2016-11-30
In thesis
1. Disease-Specific Survival in Prostate Cancer Patients: Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data
Open this publication in new window or tab >>Disease-Specific Survival in Prostate Cancer Patients: Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction

Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary.

Aims

  • To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I)
  • To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II)
  • To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III)
  • To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV)

Material and methods

The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men.

Result and conclusions

The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) < 2, limited extent of bone metastases, and a PSA level < 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1527
Keyword
Androgen deprivation treatment; bone metastases; early failure; extent of disease; hormone-naïve; long-term disease-specific survival; low-risk; mortality; quality-of-life; predictors of survival; prostate cancer.
National Category
Urology and Nephrology Cancer and Oncology Surgery Orthopedics Family Medicine
Identifiers
urn:nbn:se:liu:diva-132385 (URN)10.3384/diss.diva-132385 (DOI)9789176857168 (Print) (ISBN)
Public defence
2016-11-11, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-11-07 Created: 2016-11-07 Last updated: 2016-11-07Bibliographically approved

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The full text will be freely available from 2017-08-09 14:20
Available from 2017-08-09 14:20

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Klaff, RamiVarenhorst, EberhardSjöberg, Folke
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Department of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesUrologyDepartment of Urology in ÖstergötlandDivision of Clinical SciencesDepartment of Hand and Plastic Surgery
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Scandinavian journal of urology
Urology and Nephrology

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