Background Flashcards
What % of newly diagnosed prostate cancer pts present with locally advanced or metastatic Dz?
Appx 10%–20% of pts will present with at least locally advanced Dz.
Has the incidence of metastatic prostate cancer changed with the introduction of the PSA?
Yes. The introduction of the PSA into general practice in the early 1990s appears to have decreased the incidence of metastatic prostate cancer; a SEER database analysis showed a 52% decrease in the incidence of metastatic prostate cancer Dx from 1990 to 1994. (Stephenson RA et al., World J Urol 1997)
How are most cases of metastatic prostate cancer identified?
The majority of metastatic prostate cancer cases are identified by an isolated biochemical (PSA-only) recurrence; a much smaller proportion of cases are detected by signs/Sx of metastatic Dz (pain, pathologic fracture, weight loss, anemia, SC compression, etc.). (Lee WR et al., JCO 1997; D’Amico AV et al., JNCI 2003)
What is the anticipated natural Hx of prostate cancer after biochemical failure following local therapy?
Following local therapy and subsequent biochemical failure, the median time to development of mets is 8 yrs, and the median time to death is 13 yrs. (Pound CR et al., JAMA 1999; Freedland SJ et al., JAMA 2005)
What are common predictors of a poorer prognosis after biochemical failure following local therapy?
Poor prognostic factors after biochemical failure following local therapy include: (D’Amico AV et al., JNCI 2003; Stephenson RA et al., JAMA 2004; Zhou P et al., JCO 2005; Horwitz EM et al., IJROBP 2008)
- PSA-DT <3 mos
- GS ≥8
- T3b Dz
- LN involvement
- Short time to biochemical failure following local therapy (<3 yrs)
What is the most common site of prostate cancer mets?
The most common site is the axial skeleton, including the pelvis, vertebral column, ribs, and proximal long bones. Indeed, >80% of pts who die from prostate cancer have bony mets at autopsy. These lesions are usually osteoblastic, but may be lytic as well.
