OBJECTIVE: The aim of this study was to determine survival and prognostic factors in unselected patients with metastatic castrate-resistant prostate cancer (mCRPC), who never received life-prolonging treatment. MATERIALS AND METHODS: The study was a retrospective analysis of a consecutive sample of patients with mCRPC seen at the urological unit of a local hospital from 2000 to 2005, their mCRPC diagnosis based on rising prostate-specific antigen (PSA) during androgen depletion treatment (ADT). RESULTS: Median overall survival was 12.3 months (range 0.2-108 months), the 3 year survival was 16.9% (95% confidence interval 0.11-0.24) and two patients were alive at the end of follow-up. Compared to a PSA nadir of greater than 11 μg/l during ADT, a PSA nadir of less than 1 μg/l significantly decreased the risk of death by 71%. A PSA doubling time less than 1.6 months during the early phase of mCRCP almost tripled the risk of death compared to a PSA doubling time longer than 3 months. Alkaline phosphatase serum levels and hemoglobin levels within the normal range indicated a favorable prognosis. CONCLUSIONS: The "natural course" of mCRPC varies without life-prolonging treatment along with PSA nadir during ADT, PSA doubling time, alkaline phosphatase and hemoglobin level at mCRPC diagnosis. 3-year survival or longer is observed in 16.9% of patients. In clinical intervention trials among mCRPC patients, all known prognostic factors should be taken into account during the randomization process and during survival analyses.
OBJECTIVE: The aim of this study was to determine survival and prognostic factors in unselected patients with metastatic castrate-resistant prostate cancer (mCRPC), who never received life-prolonging treatment. MATERIALS AND METHODS: The study was a retrospective analysis of a consecutive sample of patients with mCRPC seen at the urological unit of a local hospital from 2000 to 2005, their mCRPC diagnosis based on rising prostate-specific antigen (PSA) during androgen depletion treatment (ADT). RESULTS: Median overall survival was 12.3 months (range 0.2-108 months), the 3 year survival was 16.9% (95% confidence interval 0.11-0.24) and two patients were alive at the end of follow-up. Compared to a PSA nadir of greater than 11 μg/l during ADT, a PSA nadir of less than 1 μg/l significantly decreased the risk of death by 71%. A PSA doubling time less than 1.6 months during the early phase of mCRCP almost tripled the risk of death compared to a PSA doubling time longer than 3 months. Alkaline phosphatase serum levels and hemoglobin levels within the normal range indicated a favorable prognosis. CONCLUSIONS: The "natural course" of mCRPC varies without life-prolonging treatment along with PSA nadir during ADT, PSA doubling time, alkaline phosphatase and hemoglobin level at mCRPC diagnosis. 3-year survival or longer is observed in 16.9% of patients. In clinical intervention trials among mCRPC patients, all known prognostic factors should be taken into account during the randomization process and during survival analyses.
Authors: Katharina Beyer; Lisa Moris; Michael Lardas; Anna Haire; Francesco Barletta; Simone Scuderi; Megan Molnar; Ronald Herrera; Abdul Rauf; Riccardo Campi; Isabella Greco; Kirill Shiranov; Saeed Dabestani; Thomas van den Broeck; Sujenthiran Arun; Mauro Gacci; Giorgio Gandaglia; Muhammad Imran Omar; Steven MacLennan; Monique J Roobol; Bahman Farahmand; Eleni Vradi; Zsuzsanna Devecseri; Alex Asiimwe; Jihong Zong; Sara J Maclennan; Laurence Collette; James NDow; Alberto Briganti; Anders Bjartell; Mieke Van Hemelrijck Journal: BMJ Open Date: 2022-04-04 Impact factor: 2.692