Blood Values
The lymph node–only group had the lowest median PSA and alkaline phosphatase values, but they had the highest median hemoglobin levels in comparison to the other patients. The liver metastases group had the highest alkaline phosphatase and lowest hemoglobin median levels. Men with bone and nodal disease had the highest median PSA.

Risk of Death


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Patients with lung disease had a significantly greater risk of death than men with bone disease, and those with liver disease had a significantly greater risk of death than those with lung disease.

Overall Survival

When the researchers evaluated overall survival using Kaplan-Meier curves, the results were 31.6 months for patients with lymph node–only disease, 21.3 months for those who had bone disease, 19.4 months for lung disease, and 13.5 months for patients with liver disease.

In fact, survival of men who had liver disease was substantially worse than overall survival of men who had lung disease. There was very little difference in survival times between patients with lung metastases and those who had bone metastases, whether or not there were nodes involved. 

Thus the median survival times for patients with lung and bone metastases were 15 months to 22 months and 17 months to 23 months, respectively. Men who had lung disease (with or without bone involvement) did not live as long as those who had bone disease (with or without nodal involvement).

Conclusion

This study of almost 9000 men with mCRPC who were treated with docetaxel showed that overall survival clearly depends on the location of metastases. Patients with lung metastases lived longer than those with liver metastases, while those who had lymph node–only disease lived longer than those with lung metastases. The lymph node–only disease group had the longest survival time of all patients.

The researchers suggest that the results from this large meta-analysis demonstrate how little is known about the development of different metastatic patterns of mCRPC. They call for more research to identify underlying disease mechanisms and the development of novel treatment approaches.

REFERENCE

1. Halabi S, Kelly WK, Ma H, et al. Meta-analysis evaluating the impact of site of metastasis on overall survival in men with castration-resistant prostate cancer [published online ahead of print March 7, 2016]. J Clin Oncol. 2016 Mar 7. pii: JCO657270.