predictors of survival in disseminated prostate cancer patients receiving hormonal therapy

Background and objective. The division of patients with disseminated prostate cancer (PC) into prognostic groups may be potentially used for a differential approach to choosing the hormonal therapy (HT) option and regimen. This study was conducted to identify factors influencing survival, as well as prognostic groups in this category of patients.

Subjects. The study enrolled 113 patients with verified cT2b–4N0–1M0–1 stage PC. Their median age was 70.0 ± 7.3 years. The median pretreatment prostate-specific antigen (PSA) concentration was 309.8 ng/ml. The stage cT2 was diagnosed in 12 (10.6 %) patients; cT3 was in 85 (75.2 %); cT4 in 16 (14.2 %); cN+ in 32 (28.3 %); М+ in 74 (65.5 %). The median baseline Gleason score was 3.0± 0.8 ± 4.0± 0.9 =7.0± 1.6. All the patients received emergency HT: castration was carried out in 2 (1.8 %) patients; maximum androgenic block and antiandrogen monotherapy were performed in 96 (85.0 %) and 15 (13.3 %), patients, respectively. The median follow-up was 31.9± 17.7 months.

Results. Five-year progression-free, hormone-refractory prostate cancer-free, specific, and overall survivals (OS) were 29.7, 31.8, 39.3, and 26.0 %, respectively. Multivariate analysis has shown that OS is negatively influenced by the following factors: bone pain, stages cT4, М+, a nadir of PSA of  4 ng/ml (p < 0.05) and its baseline level of  100 ng/ml (р = 0.057). Good (no bone pain, a PSA level of < 100 ng/ml, сТ < T4, and М0) and poor (bone pain and/or a PSA level of  100 ng/ml, and/or stages cT4 and/or М+) prognostic groups were identified. The median OS in the groups was 39.8± 3.9 and 29.8± 4.2 months, respectively (р = 0.048).

Conclusion. In disseminated PC, bone pain, a PSA level of 100 ng/ml, cT4 and M+, and a PSA nadir of  4 ng/ml are poor predictors of OS. The patients without these indicators belong to a good prognostic group; those have one sign or more do to a poor prognostic one.