Initial treatment patterns and outcome of contemporary prostate cancer patients with bone metastases at initial presentation: data from CaPSURE.

BACKGROUND: The current study utilized the CaPSURE disease registry to describe the natural history, initial treatment, and factors correlated with mortality in patients who were diagnosed with bony metastatic disease (M+) at the time of initial presentation.
METHODS: Treatment patterns at the time of diagnosis were analyzed. Two Cox proportional hazards models were developed, with outcomes of all cause-specific mortality and prostate cancer-specific mortality in patients with M+ disease. Clinical and sociodemographic variables were included in a backward stepwise procedure to identify predictors of mortality.
RESULTS: Of 12,005 patients diagnosed between 1990-2004, 284 (2.4%) were diagnosed with M+ disease. After a median follow-up period of 3.8 years, 107 patients (39%) died. Of those who died, 68 (64%) died of causes related to prostate cancer, whereas 39 (36%) had died of causes not related to prostate cancer. The 5-year survival of all patients was 71% and the median survival had not been reached at the time of last follow-up. Approximately 84% of patients received some form of hormonal therapy within 6 months of diagnosis, the use of which increased throughout the study period. Prostate cancer-specific mortality was found to be correlated with the presence of comorbid illness, younger age at diagnosis, and a Gleason score >7 in the primary tumor.
CONCLUSIONS: Patients with M+ prostate cancer have a protracted natural history and a median survival that exceeds 5 years. Hormonal therapy is the mainstay for such patients. Comorbid illness, young age at diagnosis, and cancer grade appear to negatively affect the disease-specific survival. Copyright (c) 2007 American Cancer Society.