title: Who dies from prostate cancer?
abstract: BACKGROUND
  During the last 30 years, there has been a major shift in initial staging in prostate cancer (CaP) in Western countries, with the incidence of metastases at diagnosis decreasing from over 50% in the 1970s to currently less than 10%. Yet, CaP is still the second cause of cancer death in men. We used two monthly curated databases of patients with castration-resistant prostate cancer (CRPC) to describe the natural history of patients dying of CaP in the modern era.
  
  
  METHODS
  The outcome of 190 men with metastatic CRPC treated from 2008 to 2011 was studied. The characteristics of the patients who died from CaP (n = 113 patients, 61%) were analyzed.
  
  
  RESULTS
  All 113 patients who died of CaP were assessable for the presence of metastases at diagnosis. Sixty-three patients (56%) had detectable metastases at diagnosis: 67%, 11% and 43% had bone, visceral and lymph node metastases, respectively. The median time to CRPC was 16 months and median overall survival (OS) was 5.2 years.Among the patients with localized CaP at diagnosis (n = 50, 44%), 46% had T stage ⩾ 3 and 38% had a Gleason score ⩾ 8. Overall, 64% of patients were classified as having a high-risk CaP. Only 26% who died from CaP had a Gleason score ⩽ 6. Median OS was 8.8 years.
  
  
  CONCLUSIONS
  In the modern era, approximately half of the patients who die from CaP have metastases at diagnosis. The paradigm of progression from localized disease to metastasis and eventually death is only represented in the other half, although possible initial screening and staging errors ought to be taken into consideration. More efforts are needed to conduct trials in patients with newly diagnosed metastatic CaP.
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Patrikidou
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Loriot
authors.affiliation: Institut Jean-Godinot, Reims, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Eymard
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: L
authors.initials: L
authors.lastname: Albiges
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Massard
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: E
authors.initials: E
authors.lastname: Ileana
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: M
authors.initials: M
authors.lastname: Di Palma
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: B
authors.initials: B
authors.lastname: Escudier
authors.affiliation: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
authors.forename: K
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D064129:Prostatic Neoplasms, Castration-Resistant / Q000401:mortality* / Q000473:pathology*; D012189:Retrospective Studies