The development of bone metastases is often been viewed as having significant negative implications for long term survival in men with metastatic castrate resistant prostate cancer (mCRPC). It is generally believed that bone metastases prognosticates a negative impact on both their quality of life and on survival.
Contradicting this commonly held belief has been some research which has identified a subgroup of men with mCRPC who have with bone metastases who still experience a long-term, positive response to hormone therapy (ADT) while also maintaining an acceptable quality of life for 10 years or more!
In a Swedish study conducted by Rami Klaff, MD, of Linköping University it was demonstrated that this is not necessarily true. He found that there are some independent predictors of long-term survival. They included a good performance status, limited extent of bone metastases, and a lowprostate specific antigen score (PSA) level.
Dr. Klaff evaluated 915 men taken from a prospective randomized trial by the Scandinavian Prostate Cancer Group. He classified the men 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.
Dr. Klaff found that age was not a survival factor as there t was no difference in age between the three survival groups. What he did find is that there was significant differences relating to cancer-related pain, performance status, and analgesic consumption between the three groups. They found that the majority of the subject men who experienced the long-term survival had no cancer-related pain, a good performance status, and did not require analgesics.
A multivariate analysis showed that a performance status less than 2, a PSA level of 231 ?g/L, and a Soloway score of 1 were all independent predictors of long-term survival. The researchers wrote, “Patients with a Soloway score 1 or a PSA level less than 231 ?g/L had a threefold likelihood of long-term survival compared to men with a Soloway score 2–3 or PSA level more than 231 ?g/L.”
He also found that the “overall and cause-specific survival were significantly related to the number of these favorable prognostic factors,” the men experienced. “However, none of the predictors were strong enough to reliably identify those men likely to survive longer than 10 years.”
The researchers have suggested that their study results be considered in making treatment decisions.