Premium
Quantification of skeletal metastases in castrate‐resistant prostate cancer predicts progression‐free and overall survival
Author(s) -
Tait Campbell,
Moore David,
Hodgson Clare,
Brown Michael,
Morris Thomas,
Growcott Jim,
Malone Michael,
Hughes Andrew,
Renehan Andrew,
Clarke Noel W.,
Dive Caroline
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12717
Subject(s) - medicine , hazard ratio , prostate cancer , confidence interval , cohort , oncology , metastasis , cancer , progression free survival , prostate , overall survival , urology
Objective To report a simplified and effective method for substratification of M 1 castrate‐resistant prostate cancer ( CRPC ) by correlating progression‐free ( PFS ) and overall survival ( OS ) with simple quantification of skeletal metastases. Patients and Methods In all, 561 men with M 1 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. Results Patients 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]. Conclusions Dichotomising 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.