medwireNews: In men with metastatic castration-resistant prostate cancer (mCRPC) bone pain is the strongest predictor of skeletal-related events (SREs), while the number of bone metastases is the strongest predictor of mortality, suggests an analysis of the US SEARCH database.
Among 837 men included in the study, the 362 who experienced bone pain were nearly threefold more likely to experience SREs than the 341 with no bone pain, during a median 14 months of follow-up, where an SRE was defined as a pathological fracture, radiotherapy or surgery to the bone, or spinal cord compression.
Stephen Williams (The University of Texas Medical Branch at Galveston, USA) and study co-authors highlight that their results align with previous studies identifying bone pain as the greatest predictor of SREs in both mCRPC and breast cancer patients.
Additionally, Williams and team found that patients concurrently diagnosed with bone and visceral metastases had an almost twofold increased risk for experiencing SREs, compared with those initially diagnosed with only bone metastases.
Other factors – such as the time from development of castration resistance to metastasis and from androgen deprivation therapy to CRPC – were also associated with SRE risk.
The researchers further investigated the impact of these [SRE] predictors on all-cause mortality. Notably, the two most prominent predictors of SREs identified – bone pain and visceral metastases – were both additionally implicated as risk factors for all-cause mortality, increasing the risk by a significant 44% and 72%, respectively.
However, the strongest predictor of all-cause mortality was the presence of 10 or more metastatic bone lesions at the time of mCRPC diagnosis, which more than doubled the risk for mortality relative to the presence of a single metastasis. This finding was in line with previous research showing overall survival with at least 20 skeletal metastases versus five to 20, say the study authors in Cancer.
Noting that 82% of the observed SREs consisted of radiotherapy to the bone, Williams and co-authors say that “[t]he association between bone pain and an increased risk of SREs may be attributed to the palliative use of radiotherapy for painful bony metastases.”
They continue: “Given the limited number of patients who experienced SREs beyond radiotherapy to the bone, the findings of the current study warrant further investigation into the relationship between bone pain and other SREs.”
Nevertheless, the researchers maintain that “[p]atients with bone pain or >10 bone metastatic lesions should receive preventative interventions to preserve their overall quality of life and prolong survival.”
By Hannah Kitt
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