Yonsei Med J.  2015 Sep;56(5):1206-1212. 10.3349/ymj.2015.56.5.1206.

Prognostic Impacts of Metastatic Site and Pain on Progression to Castrate Resistance and Mortality in Patients with Metastatic Prostate Cancer

• Koo KC
• Park SU
• Kim KH
• Rha KH
• Hong SJ
• Yang SC
• Chung BH

• KMID: 2163610
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1206

Abstract

PURPOSE
To investigate predictors of progression to castration-resistant prostate cancer (CRPC) and cancer-specific mortality (CSM) in patients with metastatic prostate cancer (mPCa).
MATERIALS AND METHODS
A retrospective analysis was performed on 440 consecutive treatment-naive patients initially diagnosed with mPCa between August 2000 and June 2012. Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed. Cox-proportional hazards regression analyses were used to evaluate survivals and predictive variables of men with bone metastasis stratified according to the presence of pain, compared to men with visceral metastasis.
RESULTS
Metastases were most often found in bone (75.4%), followed by lung (16.3%) and liver (8.3%) tissues. Bone metastasis, pain, and high BMI were associated with increased risks of progression to CRPC, and bone metastasis, pain, PSA nadir, and ECOG PS> or =1 were significant predictors of CSM. During the median follow-up of 32.0 (interquartile range 14.7-55.9) months, patients with bone metastasis with pain and patients with both bone and visceral metastases showed the worst median progression to CRPC-free and cancer-specific survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals.
CONCLUSION
Metastatic spread and pain patterns confer different prognosis in patients with mPCa. Bone may serve as a crucial microenvironment in the development of CRPC and disease progression.

Keyword

Bone; metastasis; pain; prostate cancer; viscera

MeSH Terms

Aged
Bone Neoplasms/secondary
*Disease Progression
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Pain/diagnosis/etiology/prevention & control
Pain Measurement
Prognosis
Prostate-Specific Antigen/blood
Prostatic Neoplasms/mortality/*pathology
Prostatic Neoplasms, Castration-Resistant/mortality/*pathology
Retrospective Studies
Risk
Treatment Outcome
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Comparative survival curves of patients with metastatic prostate cancer for (A) progression to castration-resistant prostate cancer (CRPC)-free survival and (B) cancer-specific survival.

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