Clinical and therapeutic histories of men who actually die of mCRPC

Despite all the prostate cancer research over the past 30 or so years, we still have limited information about the clinical and therapeutic history of prostate cancer in men who have progressive disease and go on to die of metastatic, castration-resistant prostate cancer (mCRPC).

A new paper by Steinberger et al. in the journal Clinical Genitourinary Cancer provides a retrospective analysis of all relevant clinical and therapeutic data from a series of > 100 patients, all diagnosed and treated at a single, specific institution, and all of whom were assessed as having died from mCRPC by a single, highly experienced clinician.

The patient cohort actually comprises 119 patients, all of whom were treated at Tulane Cancer Center in New Orleans between 2008 and 2015.

Here are the data offered by Steinberger et al.:

  • Patient age at time of diagnosis of prostate cancer ranged from 40 to 85 years (median, 65 years).
  • 41/119 patients (34.4 percent) presented with evident, metastatic (TxNxM1) disease at time of initial diagnosis.
  • Over the course of their treatment
    • 67/119 patients (56 percent) received some form of definitive, primary therapy.
    • 119/119 patients (100 percent) received some form of androgen deprivation therapy (ADT).
    • 62/119 patients (52 percent) received docetaxel-based chemotherapy.
  • With respect to numbers of systemic therapies received by the patients
    • This ranged from 1 to 14 systemic therapies per patient (median, 7 systemic therapies).
    • Most such systemic therapies were secondary hormonal manipulations after initiation of mCRPC (range, 0 to 9; median 4).
  • For men who received some form of definitive, primary therapy at initial diagnosis with apparently localized disease
    • Survival times ranged from 6 to 270 months (median, 100 months).
    • Definitive primary therapy therapy was a significant predictor of longer survival.
  • For men who were initially diagnosed with metastatic prostate cancer
    • Survival times ranged from 5 to 235 months (median, 39 months).
    • Diagnosis with metastatic disease was a significant predictor of shorter survival.
  • Patient survival from time of initial diagnosis ranged from 5 to 270 months (median 69 months).
  • Patient age at time of death ranged from 47 to 95 years (median, 73 years).

The data presented by Steinberger and her colleagues will come as no surprise to the well-informed clinician, patient, or patient advocate. Clearly, on average, the men diagnosed with metastatic prostate cancer had a much shorter prostate cancer-specific life expectancy than the men initially diagnosed with localized disease, but … the data also confirm the extraordinary range of time frames over which a man can progress from initial diagnosis of prostate cancer to his death if he does, indeed, go on to die from mCRPC. These time frames reflect the variation in aggressiveness among individual cancers in individual patients. Note in particular that

  • Of the patients initially diagnosed with localized disease,
    • One had died of mCRPC within just 6 months of diagnosis.
    • Another lived for 270 months (> 22 years) from initial diagnosis.
  • Of the patients initially diagnosed with metastatic prostate cancer,
    • One had died of mCRPC within just 5 months of diagnosis.
    • Another lived for 235 months (nearly 20 years) with metastatic disease.

It is this vast variation in the aggressiveness of prostate cancers that can make it so difficult to determine the most appropriate way to manage an individual patient at the time of his initial diagnosis … and remember that, in this cohort of men, we are looking only at data from patients known to have progressed to actually die of mCRPC. This cohort takes no account of the enormous numbers of men who are diagnosed with prostate cancer but actually die of something else entirely.

4 Responses

  1. I’d like the details about the treatments and lifestyle of the one patient that lived for 235 months an with initial diagnosis of metastatic disease. I am currently in month #94 with an initial metastatic diagnosis. I am now 59 and have been through all the meds, radiations and then docataxel therapy March through July 2015. Now only on Lupron every 3 months.

  2. Dear Bruce:

    The only people who could give you those details would be the patient himself (but he has now died), a family member, or his doctors with the permission of an appropriate family member. They wouldn’t be available in the paper itself.

  3. It’s probably impossible to tell the actual numbers of those of us who die from advanced, metastatic prostate cancer. The stress on our bodies from treatments can cause cardiovascular problems, kidney and/or liver failure, stroke, and other causes, not directly attributed to prostate cancer.

    I hope that something will release me from this disease before it progresses to the point where I’m totally disabled, and helpless.

    It should be our right to die with dignity, a choice when there is no hope for recovery, and the disease has made it unbearable to continue, with no quality of life.

  4. Dear Eric:

    You are right. And in fact the vast majority of us do have the right to die with dignity when we feel we are ready to do so. We have the right to stop any form of “therapeutic” care and to request only palliative care that will prevent pain and suffering. The best place to get such care is through hospice care. The hard thing for most of us is to make the decision to request this type of care and to persuade our family members that this is what they should want for us too.

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