Those numbers are out of date, even if they were written just last year.
March 11, 2004 Â A prostate cancer who ventures to read medical journals or abstracts of clinical studies about his disease may come away with a dismal picture of his prospects.
Many of these studies declare matter of factly that prognosis or median life expectancy for a man with hormone refractory prostate cancer is 12 to 14 months. Is that all?
No, it is not true. Those numbers are out of date, even if they were written just last year. A study in April 2004 Journal of Urology points out that the old "12 to 18-month duration of survival of patients with hormone refractory prostate cancer" is not consistent with current clinical experience.
These investigators studied overall survival and the clinical variables that influence survival in patients with hormone refractory prostate cancer. They focused on 254 patients with prostate cancer on androgen deprivation therapy.
Hormone refractory prostate cancer was defined as the first in a series of PSA elevations despite castrate levels of testosterone. The duration of survival in the hormone refractory phase was calculated from the date of the first PSA elevation to the date of death.
Median survival after hormone refractory prostate cancer developed in patients initially staged with or without skeletal metastasis was 40 or 68 months, respectively.
Six of more than 25 variables were judged significant in the final analysis. Variables associated with longer survival were:
- lower nadir PSA
- younger age
- higher pretreatment testosterone
- no history of obstructive uropathy
- no history of tobacco use (past or current)
- lower alkaline phosphatase
One reason for underestimation of median survival in hormone refractory prostate cancer patients, these authors suggest, is because most survival data are derived from clinical trials, but patients usually don't enter clinical trials till late in their illness.
Predictions of survival in patients with hormone refractory prostate cancer should consider all the variable, including those above, the authors say.
Wise patients and advocates would add, while some variables are fixed (like age) others can be influenced by quality of treatments and by some lifestyle choices. Patients and their caring partners can take active steps to improve the odds.
Secondly, over time the PSA test has led to earlier diagnosis and improved supportive care. Improvements in early detection and improved care are ongoing. Further, as cancer survivor Stephen Jay Gould said eloquently and we all need to keep in mind, "The median is not the message."
The Journal of Urology : Volume 171(4) April 2004 pp 1525-1528 SURVIVAL OF PATIENTS WITH HORMONE REFRACTORY PROSTATE CANCER IN THE PROSTATE SPECIFIC ANTIGEN ERA OEFELEIN, MICHAEL G.; AGARWAL, PIYUSH K.; RESNICK, MARTIN I. From the Department of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio
This page reported by J. Strax March 11, 2004; last updated May 18, 2005.
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