Long-Term Survival Possible in Prostate Cancer With Bone Mets

Researchers have identified a subgroup of men with prostate cancer and bone metastases who were able to have a positive long-term response to androgen deprivation therapy while maintaining an acceptable quality of life for 10 years or longer.

“Independent predictors of long-term survival were identified as good performance status, limited extent of bone metastases, and a low PSA [prostate-specific antigen] level at the time of enrollment,” wrote study author Rami Klaff, MD, of Linköping University in Sweden, and colleagues in BJU International. “The outcome from our study should be taken into consideration when deciding on treatment for men with metastasizing prostate cancer.”

The study included 915 men with prostate cancer taken from a prospective randomized trial by the Scandinavian Prostate Cancer Group. The trial compared parenteral estrogen with total androgen blockade. Quality of life was assessed using the EORTC QLQ-30 ratings.

The researchers classified participants by length of survival: short-term (less than 5 years), medium-term (5–10 years), and long-term (more than 10 years). Forty (4.4%) of the 915 patients survived longer than 10 years.

No difference in age was found between the three survival groups. However, the analysis did reveal significant differences relating to cancer-related pain, performance status, and analgesic consumption between the groups (P < .001). Specifically, the majority of patients with long-term survival had no cancer-related pain, a good performance status, and did not require analgesics.

Klaff and colleagues identified several prognostic factors associated with long-term survival. A multivariate analysis showed that a performance status less than 2, a PSA level of 231 μg/L, and a Soloway score of 1 were all independent predictors of long-term survival. For example, the researchers wrote, “Patients with a Soloway score 1 or a PSA level < 231 μg/L had a threefold likelihood of long-term survival compared to men with a Soloway score 2–3 or PSA level > 231 μg/L.”

“Overall and cause-specific survival were significantly related to the number of these favorable prognostic factors,” the researchers wrote. “However, none of the predictors were strong enough to reliably identify those men likely to survive longer than 10 years.”

The overall mean quality of life score was 56.7. The quality of life analysis showed a mean value of global health status of 62.8 for short-term survivors, 69.7 for medium-term survivors, and 72.6 for long-term survivors. Long-term survivors reported problems with increasing fatigue and dyspnea during follow-up compared with baseline.