Kenichi Nakajima1, Atsushi Mizokami2, Hideyasu Matsuyama3, Tomohiko Ichikawa4, Go Kaneko5, Satoru Takahashi6, Hiroaki Shiina7, Hiroyuki Horikoshi8, Katsuyoshi Hashine9, Yutaka Sugiyama10, Takeshi Miyao11, Manabu Kamiyama12, Kenichi Harada13, Akito Ito14. 1. Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan. 2. Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. 3. Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan. 4. Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan. 5. Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan. 6. Department of Urology, Nihon University School of Medicine, Tokyo, Japan. 7. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan. 8. Department of Diagnostic Radiology, Gunma Prefectural Cancer Center, Ota, Japan. 9. Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. 10. Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 11. Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan. 12. Department of Urology, University of Yamanashi, Yamanashi, Japan. 13. Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan. 14. Department of Urology, Iwate Medical University, Yahaba, Japan.
Abstract
OBJECTIVE: To determine prognostic factors including the Bone Scan Index in prostate cancer patients receiving standard hormonal therapy and chemotherapy. METHODS: This multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index study involved 30 hospitals and enrolled 247 patients (age 71 ± 8 years) with metastatic hormone-sensitive prostate cancer (n = 148) under hormone therapy and metastatic castration-resistant prostate cancer (n = 99) under chemotherapy. The Bone Scan Index (%) was determined by whole-body bone scintigraphy using 99m Tc-methylenediphosphonate. Patients were classified into tertiles and binary groups, and predictors of all-cause death including Bone Scan Index, prostate-specific antigen, and bone metabolic markers were determined using survival and proportional hazard analyses. RESULTS: During a mean follow-up period of 716 ± 404 days, 81 (33%) of the patients died, and 3-year mortality rates were 20% and 52% in the metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer groups, respectively. Survival analysis showed that a Bone Scan Index >3.5% was a significant determinant of death in the metastatic hormone-sensitive prostate cancer group, whereas prostate-specific antigen >55 ng/mL before chemotherapy was a determinant of prognosis in the metastatic castration-resistant prostate cancer group. A Bone Scan Index >3.5% was also associated with a high incidence of prostate-specific antigen progression in the metastatic hormone-sensitive prostate cancer group. Patients with metastatic hormone-sensitive prostate cancer and a better Bone Scan Index response (>45%) to treatment had lower mortality rates than those without such response. CONCLUSION: The Bone Scan Index and hot spot number are significant determinants of 3-year mortality, and combining the Bone Scan Index with prostate-specific antigen should contribute to the management of prostate cancer patients with bone metastasis.
OBJECTIVE: To determine prognostic factors including the Bone Scan Index in prostate cancerpatients receiving standard hormonal therapy and chemotherapy. METHODS: This multicenter Prostatic Cancer Registry of Standard Hormonal and Chemotherapy Using Bone Scan Index study involved 30 hospitals and enrolled 247 patients (age 71 ± 8 years) with metastatic hormone-sensitive prostate cancer (n = 148) under hormone therapy and metastatic castration-resistant prostate cancer (n = 99) under chemotherapy. The Bone Scan Index (%) was determined by whole-body bone scintigraphy using 99m Tc-methylenediphosphonate. Patients were classified into tertiles and binary groups, and predictors of all-cause death including Bone Scan Index, prostate-specific antigen, and bone metabolic markers were determined using survival and proportional hazard analyses. RESULTS: During a mean follow-up period of 716 ± 404 days, 81 (33%) of the patientsdied, and 3-year mortality rates were 20% and 52% in the metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer groups, respectively. Survival analysis showed that a Bone Scan Index >3.5% was a significant determinant of death in the metastatic hormone-sensitive prostate cancer group, whereas prostate-specific antigen >55 ng/mL before chemotherapy was a determinant of prognosis in the metastatic castration-resistant prostate cancer group. A Bone Scan Index >3.5% was also associated with a high incidence of prostate-specific antigen progression in the metastatic hormone-sensitive prostate cancer group. Patients with metastatic hormone-sensitive prostate cancer and a better Bone Scan Index response (>45%) to treatment had lower mortality rates than those without such response. CONCLUSION: The Bone Scan Index and hot spot number are significant determinants of 3-year mortality, and combining the Bone Scan Index with prostate-specific antigen should contribute to the management of prostate cancerpatients with bone metastasis.