Prognostic Factors for Hormone Sensitive Metastatic Prostate Cancer: Impact of Disease Volume

Document Type: Research Articles

Authors

1 Department of Clinical Oncology and Nuclear Medicine,Faculty of Medicine, Menoufia University, Egypt.

2 Department of Urology,Faculty of Medicine, Menoufia University, Egypt.

3 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Egypt.

4 Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Egypt.

Abstract

Background and Aim: The optimal management of metastatic hormone-sensitive prostate cancer has been
controversial in recent years with introduction of upfront chemohormonal treatment based on results of several Western
studies. This changing landscape has renewed interest in the concept “disease volume”, the focus of the present study
is the Egyptian patients. Methods: Patients with hormone sensitive metastatic prostate cancer presenting at Menoufia
University Hospital, Egypt, during the period from June 2013 to May 2016, were enrolled. All received hormonal
treatment. Radiologic images were evaluated and patients were stratified according to their disease volume into high or
low, other clinical and pathological data that could affect survival also being collected and analyzed. Results: A total
of 128 patients were included, with a median age of 70 years (53.9% ≥70). About 46% had co-morbidities, 62% having
high volume disease. During the median follow up period of 28 months about half of the patients progressed and one
third received chemotherapy. On univariate analysis, disease volume, performance status (PS), prostate specific antigen
level (PSA) and presence of pain at presentation were identified as factors influencing overall survival. Multivariate
analysis revealed the independent predictor factors for survival to be PS, PSA and disease volume. The median overall
survival with 27 months was high volume versus 49 with low volume disease (hazard ratio 2.1; 95% CI 1.2 - 4.4;
P=0.02). Median progression free survival was 19 months in the high volume, as compared with 48 months in the low
volume disease patients (hazard ratio, 2.44; 95% CI, 1.42 – 7.4; P=0.009). Conclusions: Disease volume is a reliable
predictor of survival which should be incorporated with other important factors as; patient performance status and
comorbidities in treatment decision-making.

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