Site of prostate cancer metastasis and length of patient survival

There has long been information suggesting that exactly where prostate cancer metastasizes to (outside of the prostate itself) is really important to how long a patient might reasonably expect to survive once metastasis is evident. This is why patients with higher-risk disease get both a bone scan and a CT scan at diagnosis.

In a new paper in yesterday’s issue of the Journal of Clinical Oncology, Halabi et al. have provided us with new and important insights into this topic that had not previously been available … and the list of authors of this new paper is pretty much a “who’s who” of leading figures from the prostate cancer research community! A media release about this study issued by Duke University Medical Center is also available on line.

What Susan Halabi and her colleagues did was to look at the individual patient data for 8,820 men, all of whom had metastatic, castration-resistant prostate cancer (mCRPC), and all of whom received docetaxel-based chemotherapy after enrollment in any one of nine different Phase III clinical trials of drugs for the treatment of advanced prostate cancer.

They categorized the patients into four different groups, as follows:

  • Group A: Patients with lymph node-only metastasis
  • Group B: Patients with bone metastasis with or without lymph node metastasis, but no other visceral (i.e., soft tissue) metastasis
  • Group C: Patients with any amount of lung metastasis, but no liver metastasis
  • Group D: Patients with any amount of liver metastasis

They then looked at the overall survival times of the 8,820 patients and found the following:

  • The proportions of patients in each group were
    • 6.4 percent in Group A
    • 72.8 percent in Group B
    • 20.8 percent in Groups C and D
  • Average (median) overall survival rates by group were
    • 31.6 months for men in Group A
    • 21.3 months for men in Group B
    • 19.4 months for men in Group C
    • 13.4 months for men in Group D

Thus Halabi et al. have now been able to confirm what many researchers have long suspected, which is that site of metastasis is a powerful predictor of prostate cancer mortality in men with very advanced disease. But readers need to remember that these survival times are times from enrollment in particular trials after a patient was known to be both metastatic and castration resistant. These data do not tell us how long the patients may have survived since their initial diagnosis or even how long they may have been on androgen deprivation therapy (ADT) prior to becoming castration resistant.

The authors conclude that:

Specific sites of metastases in men with mCRPC are associated with differential [overall survival], with successive increased lethality for lung and liver metastases compared with bone and nonvisceral involvement. These data may help in treatment decisions, the design of future clinical trials, and understanding the variation in biology of different sites of metastases in men with mCRPC.

What this study does not, of course, tell us is why a specific patient may get metastases in his lungs or his liver as opposed to just his bones.

The question many patients are going to ask, based on these data, is this one:

So does this mean that if I am diagnosed initially with metastasis to the liver, or, when my cancer first starts to metastasize, it has metastasized to the liver, I am liable to do much worse than if it has only metastasized to the lymph nodes or the bones?

As yet, we cannot answer that question with high quality data of the type provided by Halabi and her colleagues for men with mCRPC. What The “New” Prostate Cancer InfoLink would tell readers, however, is that men with early metastases to soft tissues like the lungs and the liver are widely believed by most specialists to be at greater risk for earlier and faster progression of their disease than men with only metastasis to the lymph nodes and/or the bones.

One Response

  1. I have had both lymph node and bone metastases for a number of years, yet I can say with some confidence that it’s strictly an individual disease where depending on your level of care, your decision to fight for the best treatment, and your continued learning curve about the nature of disease phenotype is how long you’re going to survive. … Last week my PSA was 1.10 ng/ml on enzalutamide, sipuleucel-T, dutasteride and Zometa.

    Fight on. … You’ve got nothing better to do!

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