Prostate cancer metastases to bone: observational study for the evaluation of clinical presentation, course and treatment patterns. Presentation of the METAURO protocol and of patient baseline features.
ABSTRACT The aim of the present study is to describe the research protocol and preliminary results of an observational survey on presentation patterns of prostate cancer metastasis to bone (METAURO), involving urology departments in several Italian hospitals.
The study design was observational and inclusion criteria required subjects with prostate cancer patients who were first diagnosed with metastatic bone disease not more than 18 months before. For each patient recruited to the study, a retrospective evaluation and a prospective surveillance were undertaken.
One hundred and ninety-nine patients were enrolled at 32 urological centers in Italy. The median age of participants at first visit was 72.7 years (SD = 7.8). Mean PSA at onset was 323.6 (SD = 1058.3) and these values strongly correlated with Gleason score (Spearman r = 0.228; p = 0.003). The main cause for suspicion of bone metastasis was routine follow up (53%), followed by pathological fracture (31%). Main metastasis sites were located at femur (43.2%), lumbar sacral spine (39.7%), cervical spine (38.2%) and ribs (33.7%). With regard to the main types of bone metastases identified, 27.6% were sclerotic, 5% were lytic and 21.1% were mixed. The specialist who most frequently suspected bone metastasis and referred patients for diagnostic assessment was an urologist (84.9%).
The present survey is a multicentric study with the main aim to identify features of prostate cancer patients with bone metastases. This survey confirmed that suspicion of bone metastasis is motivated by pain symptoms only in a small percentage of patients with prostate cancer, which testifies to both the difficulty of diagnosis and the need and usefulness of accurate regular follow up.
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ABSTRACT: The purpose of the present study was to investigate the distribution characteristics of bone metastases in breast and prostate carcinomas. Bone scintigraphies were performed in 504 cancer patients. We studied the correlation between the distribution and total number of metastatic bone lesions, and compared the distribution of metastatic bone lesions between breast and prostate carcinomas. In the early stage, the distribution in the thoracic vertebrae, lumbar vertebrae and pelvis of the metastatic lesions of the prostate carcinoma (81.0%, 47/58) was significantly higher than that of the breast carcinoma (41.7%, 63/151; χ(2)=27.6, P=0.000). The distribution of the lesions in the thoracic skeleton in the cases of the breast carcinoma (65.6%, 99/151) was significantly higher than that of the prostate carcinoma (27.6%, 16/58; χ(2)=24.8, P=0.000); however, the distributions in the advanced cases were not markedly different. The differences in the proportions of the metastatic lesions in the lumbar vertebrae (χ(2)=56.1, P=0.000) and ribs (χ(2)=39.1, P=0.000) in the cases of the prostate carcinoma, and in the sternum (χ(2)=31.2, P=0.000), skull (χ(2)=26.5, P=0.000) and femur (χ(2)=13.6, P=0.001) in the cases of the breast carcinoma were significant. Between the breast and prostate carcinomas, the differences in the proportions of the metastatic lesions of certain bones were also significant. In cases with few bone metastases, the proportion of sternum metastases of patients with breast carcinoma (17.9%) was significantly higher than that of patients with prostate carcinoma (1.7%; χ(2)=12.7, P=0.000); the proportion of metastases in the lumbar vertebrae of prostate carcinoma (39.7%) was significantly higher than that of breast carcinoma (13.9%; χ(2)=15.4, P=0.000); the proportion of rib metastases of breast carcinoma (27.2%) was significantly higher than that of prostate carcinoma (8.6%; χ(2)=9.6, P=0.002). In cases with extensive bone metastases, the proportions of metastatic lesions in the sternum and lumbar vertebrae in breast and prostate carcinomas were not significantly different (P>0.05). In conclusion, the distribution of bone metastases is correlated with the total number of metastatic bone lesions in breast and prostate carcinoma patients, and has different characteristics in different lesions.Oncology letters 01/2013; 5(1):391-397. · 0.24 Impact Factor
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ABSTRACT: The aim of this study was to explore the distribution features of metastatic bony lesions in prostate cancer. Bone scans with 99mTc-methylene diphosphonate were performed in 144 patients with pathologically proven prostate cancer, and distribution regularity of metastatic bony lesions was analyzed retrospectively. A total of 2000 lesions of bone metastasis were detected in 102 patients, 28.9% of which were distributed in the ribs, 14.8% in thoracic vertebrae, 13.8% in the ilium, and 8.0% in the lumbar vertebrae. The distribution of metastatic bony lesions was correlated with the total number of lesions. The proportion of metastatic lesions of vertebrae and pelvis was up to 84.5% (49/58) in fewer bone metastases. The proportion gradually decreased with an increase in the total number of lesions, but the proportion of the bony lesions, except for the vertebrae and pelvis, gradually increased with an increase in the total number of lesions. Ninety-nine percent (903/912) of metastatic bony lesions, except for the vertebrae and pelvis, coexisted with metastasis of vertebrae or pelvis, whereas only 1.0% (9/912) of those were detected in no metastasis of the vertebrae and pelvis; their difference was significant (χ2=876.4, P=0.000). About 98.8% (571/578) of metastatic costal lesions coexisted with vertebrae metastasis, but only 1.2% (7/578) of these were detected in no metastasis of vertebrae; their difference was significant (χ2=550.3, P=0.000). The difference between left body and right body was not significant (χ=1.3, P=0.249). Metastatic bony lesions of prostate cancer are located mainly in the vertebrae and pelvis in the early stage. The distribution of metastatic bony lesions is not only characterized by spreading to left body and right body randomly, but also presents the tendency of developing with orderliness to a certain extent in the whole body.Nuclear Medicine Communications 04/2012; 33(4):379-83. · 1.38 Impact Factor
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ABSTRACT: To identify the clinical features and independent predictors of survival in patients with bone metastases from prostate cancer (PCa). We retrospectively analysed 115 PCa patients with bone metastases between 1997 and 2009. The overall survival rate after bone metastases was calculated using the Kaplan-Meier method. The prognostic factors were identified by univariate analysis using a log-rank test and by multivariate analysis using Cox proportional hazards regression models. The follow-up rate was 100%, the follow-up cases during 1, 3 and 5 years were 103, 79 and 55, respectively. The 1-, 3- and 5-year survival rates were 89.1%, 60.9% and 49.8%, respectively, with a median survival time of 48.5 months for patients with bone metastases from PCa. In univariate analysis, age, Gleason score, clinical stage, the number of bone lesions, alkaline phosphatase (ALP) level, invasion of neighbouring organs and non-regional lymph node metastases were correlated with prognosis. By multivariate analysis using Cox regression, ALP level, Gleason score and non-regional lymph node metastases were independent prognostic factors. These prognostic factors will help us to determine the appropriate dose and fraction of radiotherapy for these patients.Asian Journal of Andrology 04/2012; 14(3):505-8. · 2.14 Impact Factor