Clinical presentation and predictors of survival related to extent of bone metastasis in 900 prostate cancer patients.
OBJECTIVE
The aim of this study was to investigate the impact of bone metastasis on survival and quality of life (QoL) in men with hormone-naïve prostate cancer.


METHODS
The study included 900 patients from a randomized trial (No. 5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade. Extent of bone metastasis was categorized according to a modified Soloway score: score 1, n = 319; score 2, n = 483; and score 3, n = 98 patients. The primary outcome measurements were mean differences in QoL and overall survival.


RESULTS
QoL rating scales showed a decrease with increasing extent of bone metastasis (p < 0.001). The mean global health status decreased from 64.4 to 50.5 for Soloway score 1 and 3, respectively. Following adjustment for performance status, analgesic consumption, grade of malignancy, alkaline phosphatase, prostate-specific antigen, haemoglobin and global health status, Soloway score 2 and 3 had a 47% [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.21-1.80] and 78% (HR 1.78 95%, CI 1.32-2.42) increased mortality, respectively, compared to Soloway score 1. Independent predictive factors of mortality were assessed.


CONCLUSIONS
Patient grouping based on three categories of extent of bone metastasis related to performance status, haemoglobin and global health status at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis.
a Department of Urology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden ;
Rami
R
Klaff
a Department of Urology and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden ;
Eberhard
E
Varenhorst
b EpiStat , Uppsala , Sweden ;
Anders
A
Berglund
c Department of Urology , Karolinska Institute , Solna , Sweden ;
Per Olov
PO
Hedlund
d Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden ;
Folke
F
Sjöberg
e Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Centre for Digestive Diseases , Karolinska University Hospital , Stockholm , Sweden.
Gabriel
G
Sandblom
D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D011788:Quality of Life; D015996:Survival Rate
Androgen deprivation treatment; bone metastasis; extent of disease; hormone-naïve; predictors of survival; prostate cancer