title: Impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy.
abstract: OBJECTIVE
  To investigate the impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed long-term androgen deprivation therapy.
  
  
  METHODS
  This historical cohort study was conducted in two hospitals in Hong Kong. Patients who were diagnosed with metastatic prostate cancer and prescribed androgen deprivation therapy between January 2006 and December 2011 were included. Details of skeletal-related events and mortality were examined.
  
  
  RESULTS
  The median follow-up was 28 (range, 1-97) months. Of 119 patients, 52 (43.7%) developed skeletal-related events throughout the study, and the majority received bone irradiation for pain control. The median actuarial overall survival and cancer-specific survival for patients with skeletal-related events were significantly shorter than those without skeletal-related events (23 vs 48 months, P=0.003 and 26 vs 97 months, P<0.001, respectively). Multivariate analysis revealed that the adjusted hazard ratio of presence of skeletal-related events on overall and cancer-specific survival was 2.73 (95% confidence interval, 1.46-5.10; P=0.002) and 3.92 (95% confidence interval, 1.87-8.23; P<0.001), respectively. A prostate-specific antigen nadir of >4 ng/mL was an independent poor prognostic factor for overall and cancer-specific survival after development of skeletal-related events (hazard ratio=10.42; 95% confidence interval, 2.10-51.66 and hazard ratio=10.54; 95% confidence interval, 1.94-57.28, respectively).
  
  
  CONCLUSIONS
  Skeletal-related events were common in men with metastatic prostate cancer. This is the first reported study to show that a skeletal-related event is an independent prognostic factor in overall and cancer-specific survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy. A prostate-specific antigen nadir of >4 ng/mL is an independent poor prognostic factor for overall and cancer-specific survival following development of skeletal-related events.
authors.affiliation: Division of Urology, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: K W
authors.initials: KW
authors.lastname: Wong
authors.affiliation: Division of Urology, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: W K
authors.initials: WK
authors.lastname: Ma
authors.affiliation: Baptist Hospital, Kowloon Tong, Hong Kong.
authors.forename: C W
authors.initials: CW
authors.lastname: Wong
authors.affiliation: Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: M H
authors.initials: MH
authors.lastname: Wong
authors.affiliation: Division of Urology, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: C F
authors.initials: CF
authors.lastname: Tsang
authors.affiliation: Division of Urology, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: H L
authors.initials: HL
authors.lastname: Tsu
authors.affiliation: Private practice, Hong Kong.
authors.forename: K L
authors.initials: KL
authors.lastname: Ho
authors.affiliation: Division of Urology, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: M K
authors.initials: MK
authors.lastname: Yiu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary; D015331:Cohort Studies; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
keywords: Androgen antagonists/therapeutic use; Bone neoplasms; Prostatic neoplasms/therapy