Initial treatment patterns and outcome of contemporary prostate cancer patients with bone metastases at initial presentation

Abstract

The current study utilized the CaPSURE disease registry to describe the natural history, initial treatment, and factors correlated with mortality in patients who were diagnosed with bony metastatic disease (M+) at the time of initial presentation. Treatment patterns at the time of diagnosis were analyzed. Two Cox proportional hazards models were developed, with outcomes of all cause-specific mortality and prostate cancer-specific mortality in patients with M+ disease. Clinical and sociodemographic variables were included in a backward stepwise procedure to identify predictors of mortality. Of 12,005 patients diagnosed between 1990-2004, 284 (2.4%) were diagnosed with M+ disease. After a median follow-up period of 3.8 years, 107 patients (39%) died. Of those who died, 68 (64%) died of causes related to prostate cancer, whereas 39 (36%) had died of causes not related to prostate cancer. The 5-year survival of all patients was 71% and the median survival had not been reached at the time of last follow-up. Approximately 84% of patients received some form of hormonal therapy within 6 months of diagnosis, the use of which increased throughout the study period. Prostate cancer-specific mortality was found to be correlated with the presence of comorbid illness, younger age at diagnosis, and a Gleason score >7 in the primary tumor. Patients with M+ prostate cancer have a protracted natural history and a median survival that exceeds 5 years. Hormonal therapy is the mainstay for such patients. Comorbid illness, young age at diagnosis, and cancer grade appear to negatively affect the disease-specific survival.