Prevalence of skeletal complications and their impact on survival of hormone refractory prostate cancer patients in Japan

Abstract

Objectives: Skeletal complications are a crucial factor in the quality of life and the prognosis of patients with hormone-refractory prostate cancer (HRPC); however, their true prevalence and impact on the prognosis remain largely unknown. In this study, we retrospectively investigated the prevalence of skeletal complications and survival of HRPC patients in a single Japanese institute.

Methods: From 1990 to 2004, 151 patients with prostate cancer were estimated to have HRPC after androgen ablation therapy in a single institute. The medical records of the patients were reviewed for documentation of skeletal complications, and overall survival was calculated from the diagnosis of HRPC.

Results: At the diagnosis of HRPC, bone metastases and bone pain were observed in 83.8% and 44.7% of patients, respectively. During follow-up, 80.0% and 14.2% of patients experienced bone pain and bone fracture, respectively. Moreover, 74.2% and 43.9% of the patients received nonsteroidal anti-inflammatory drugs and opioids for bone pain, respectively, and 50.9% of the patients underwent radiotherapy for palliative pain control. A high score on the extent of disease observed on the bone scan and the presence of bone pain at the diagnosis of HRPC were independent prognostic factors on multivariate analysis (hazard ratio = 1.753 and 2.118, P = .033 and .007, respectively).

Conclusions: Despite a small number of subjects, our retrospective survey demonstrated the high prevalence and mortality rate of skeletal complications in Japanese HRPC patients. Patients with bone pain at the diagnosis of HRPC had significantly poorer prognosis than those without.