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Do skeletal-related occasions predict general survival in males with metastatic castration-resistant prostate most cancers?

Prostate Most cancers Prostatic Dis. 2016 Dec;19(four):380-384

Authors: Howard LE, De Hoedt AM, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Terris MK, Divers CH, Valderrama A, Freedland SJ

Summary
BACKGROUND: Skeletal-related occasions (SREs) together with pathologic fracture, spinal wire compression, radiation to bone and surgical procedure to bone, are frequent in males with bone metastatic castration-resistant prostate most cancers (mCRPC). Males with mCRPC are at excessive threat of demise. Whether or not SREs predict mortality is unclear. We examined the affiliation between SREs and general survival (OS) in a multiethnic cohort with bone mCRPC, controlling for key covariates unavailable in claims knowledge akin to bone ache, variety of bone metastases and PSA doubling time (PSADT).
METHODS: We collected knowledge on 233 males recognized with nonmetastatic castration-resistant prostate most cancers (CRPC) in 2000-2013 at two Veterans Affairs hospitals who later progressed to bone metastases. First incidence of SRE and OS had been collected from the medical information. Cox fashions had been used to check the affiliation between SRE and OS, treating SRE as a time-dependent variable. We adjusted for age, yr, race, remedy heart, biopsy Gleason, major remedy to the prostate, PSA, PSADT, months from androgen deprivation remedy to CRPC, months from CRPC to metastasis and variety of bone metastases at preliminary bone metastasis analysis. In a secondary evaluation, we additionally adjusted for bone ache.
RESULTS: Throughout follow-up, 88 (38%) sufferers had an SRE and 198 (85%) died. After adjusting for threat components, SRE was related to elevated mortality (hazard ratio (HR)=1.67; 95% confidence interval (CI) 1.22-2.30; P=zero.001). When bone ache was added to the mannequin, the affiliation of SREs and OS was attenuated, however remained important (HR=1.42; 95% CI 1.01-1.99; P=zero.zero42).
CONCLUSIONS: SREs are related to elevated mortality in males with bone mCRPC. Additional research on the influence of stopping SREs to extend survival are warranted.

PMID: 27377207 [PubMed – indexed for MEDLINE]