Background: Previous studies have reported on prognostic factors for castrationresistant prostate cancer (CRPC); however, most of these studies were conducted before docetaxel chemotherapy was approved for CRPC. Objective: To evaluate the prognostic value of multiple parameters in men with bone metastases due to CRPC using a contemporary dataset. Design, setting, and participants: The analysis included 1901 patients with metastatic CRPC enrolled in an international, multicenter, randomized, double-blind phase 3 trial conducted between May 2006 and October 2009. Outcome measures and statistical analysis: We developed multivariate validated Cox proportional hazards models and nomograms to estimate 12-mo and 24-mo survival probabilities and median survival time. Results and limitations: The median (95% confidence interval) overall survival was 20 (18, 21) mo. The final model included 12 of the 15 potential prognostic variables evaluated (concordance index 0.72). Seven bone-related variables were associated with longer survival in the final model: alkaline phosphatase ≥143 U/l ( p < 0.0001); bone-specific alkaline phosphatase (BSAP) < 146 U/l (p < 0.0001); corrected urinary N-telopeptide (uNTx) ≥50 nmol/mmol (p = 0.0008); mild or no pain (Brief Pain Inventory- Short Form [BPI-SF] score ≥4) (p < 0.0001); no previous skeletal-related event (SRE; p = 0.0002); longer time from initial diagnosis to first bone metastasis (p < 0.0001); and longer time from first bone metastasis to randomization (p < 0.0001). Other significant predictors of improved survival included prostatespecific antigen (PSA) level < 10 ng/ml (p < 0.0001), hemoglobin >128 g/l (p < 0.0001), absence of visceral metastases (p < 0.0001), Eastern Co-operativeOncology Group (ECOG) score ≥1 (p = 0.017), and younger age (p = 0.008). Nomograms were generated based on the parameters included in the final validatedmodels (with/without uNTx and BSAP). One limitation was that lactate dehydrogenase (LDH) levels, a known prognostic factor, were not available in this study. Conclusions: Bone-related parameters are strong prognostic variables for overall survival in patients with bone metastases from CRPC. Patient summary: Survival time is variable in patients with bone metastases from prostate cancer. We found that factors related to bone help to predict how long a patient will live. #2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
- Bone metastases
- Castration-resistant prostate cancer
- Prognostic factors
ASJC Scopus subject areas