Bone metastasis, skeletal events predict poor prostate CA prognosis


NEW YORK (Reuters Health), Jun 11 - Among men with prostate cancer, those with bone lesions and skeletal events have the worst survival, with fewer than 1% alive at five years, a large Danish study shows.

In the nationwide study of close to 23,000 patients, about 8% developed bone metastases within a year of their prostate cancer diagnosis, and within a year after that, almost half had at least one skeletal event -- that is, radiation to the bone, fracture, or bone surgery.

Lead author Dr. Mette Norgaard of Aarhus University Hospital and colleagues used registry data from 1999 to 2007 to analyze all-cause mortality in men with prostate cancer with and without bone metastasis and skeletal events. The median follow-up was 2.2 years.

They report in the July issue of the Journal of Urology that 569 men had bone metastasis by the time they were diagnosed with prostate cancer, and 248 of these (43.6%) had a skeletal event during follow-up.

Of the 22,404 who did not have bone metastases at diagnosis, 2,578 (11.5%) developed them during follow-up, and more than half (n = 1,329; 51.6%) also had skeletal related events.

Patients without bone metastases had one- and five-year survival rates of 87.0% and 55.8%, respectively -- but one- and five-year survival dropped to 47.4% and 2.7%, respectively, in men with bone lesions, and to 39.9% and 0.7%, respectively, in men with bone lesions and skeletal related events.

After adjusting for age and comorbidity, the mortality rate ratio remained higher in men with bone metastasis (4.7 at one year, and 6.1 beyond one year) and even higher in men with bone metastasis plus a skeletal event (6.6 at one year and 9.8 beyond one year), according to the article.

Treatment to prevent bone metastasis and delay time to the first skeletal related event in men who already have bone lesions "could be beneficial for all men with prostate cancer," the study team says.

J Urol 2010;184:162-167.

Last Updated: 2010-06-11 12:36:28 -0400 (Reuters Health)

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