Men who develop bone metastases have often been viewed as having developed a significant negative change that prognosticates a negative impact on both their quality of life and on their survival.
Contradicting this commonly held belief has been some research which has identified a subgroup of men with advanced prostate cancer with bone metastases who still experience a long-term, positive response to hormone therapy (ADT or androgen deprivation therapy) while also maintaining an acceptable quality of life for 10 years or more.
The study author, Rami Klaff, MD, of Linköping University in Sweden found that the “Independent predictors of a possible long-term survival were a good performance status, limited extent of bone metastases, and a low PSA [prostate-specific antigen] level at the time of enrollment.”
The researchers, evaluating 915 men taken from a prospective randomized trial by the Scandinavian Prostate Cancer Group, 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.
The researchers found that there were no difference in age between the three survival groups. However, they did find that there was significant differences relating to cancer-related pain, performance status, and analgesic consumption between the groups. They found that the majority of 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.”
“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 researchers concluded that “The outcome from our study should be taken into consideration when deciding on treatment for men with metastasizing prostate cancer.”