Clinical prognostic factors in patients with advanced stage prostate cancer

ABSTRACT

Objectives: To determine the prognostic factors that could predict patient outcome in patients with advanced stage prostate cancer. Patients and Methods: In this study we retrospectively evaluated the medical record data of 222 patients with advanced stage prostate cancer treated by hormonal therapy (either castration or total androgen blockade (TAB)). All pre- and post- treatment data records were evaluated with respect to patient age; prostate and tumor size; tumor grade; stage; PSA; alkaline and acid phosphatase and the number of bone lesions. The response to the hormonal treatment was evaluated either early (12 months after treatment) or late (over all follow-up visits until the last visit or death). Descriptive statistics; student T test; multivariate and Kaplan Meier's curve were used for data analysis. Results: Within 12 months of treatment 70of the cases showed an improvement with a significant decrease of their pre-treatment values after hormonal therapy. Patient age; tumor stage; the number of bone lesions; serum alkaline and acid phosphatase levels in the pre-treatment data were significantly independent predictors of the overall survival outcome (p= 0.0015; 0.002; 0.001; 0.0002 and 0.028; respectively); while the pre-treatment PSA serum level; tumor grade and the type of hormonal treatment used (either castration or TAB) were no predictors of patient outcome (p= 0.18; 0.82 and 0.47; respectively). Importantly; the PSA serum level and the number of bone lesions in the first 12 months of patient follow-up were significant predictors of the overall disease survival status (p=0.001 and 0.028; respectively). The mean follow-up period of alive cases was 39.42 months ranging from 6 - 171 months. Of the 222 cases 110 (51.6) had overall disease progression during a mean of 59.4 months; while mortality was reported in 118 cases (53.2) in the course of a mean of 59.9 months. Conclusion: The pre-treatment patient age; tumor stage; serum alkaline and acid phosphatase; as well as the post-treatment PSA level and the number of bone lesions were significant independent predictors of the overall patient outcome in patients with advanced stage prostate cancer. However; a survival analysis in relation to the treatment type did not reveal a statistically significant difference between the outcomes of castration and TAB