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

Abstract

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